Objective: To analyze the effectiveness of proximal humeral internal locking system (Philos) plate for proximal humerus fracture.
Methods: Thirty-three patients with proximal humerus fracture were treated with open reduction and internal fixation with Philos plate between January 2009 and January 2014. There were 19 males and 14 females, aged 23-89 years (mean, 56.6 years). The left side was involved in 15 cases, and the right side in 18 cases. The injury causes included falling in 20 cases and traffic accident in 13 cases. All cases received X-ray and CT scan and three-dimensional reconstruction before operation. According to the Neer classification, 8 cases were rated as two-part fractures, 15 cases as three-part fractures, and 10 cases as four-part fractures. The interval time between injury and surgery was 1-7 days (mean, 3.67 days). Postoperative functional outcome was evaluated using the Constant-Murley score.
Results: Infection and liquefaction occurred in 2 cases respectively, which was cured after corresponding treatment; primary healing of wound was obtained in the other 29 cases. Five patients had shoulder pain. The patients were followed up 11-47 months (mean, 33 months). The mean time of fracture union was 7.5 months (range, 5-9 months) on the X-ray films. Humeral head necrosis occurred in 2 patients with Neer four-part fractures, and internal fixation failure occurred in 3 patients (2 screw broken and 1 plate broken) with four-part fractures (2 cases) and three-part fractures (1 case), which was cured after conservative treatment. At last follow-up, the mean Constant-Murley score was 70.5 (range, 42-90); the results were excellent in 3 cases, good in 21 cases, moderate in 6 cases, and poor in 3 cases.
Conclusions: Satisfactory results can be expected for proximal humeral fracture by using of the proximal humeral internal locking system plate based on strict indication and early rehabilitation training.
目的: 总结应用肱骨近端内固定锁定系统（Philos钢板）治疗肱骨近端骨折的手术疗效。.
方法: 2009年1月-2014年1月，采用经三角肌劈开入路Philos钢板治疗33例肱骨近端骨折。其中男19例，女14例；年龄23～89岁，平均56.6岁。左侧15例，右侧18例。致伤原因：摔伤20例，交通事故伤13例。术前行X线片、CT及三维重建检查，Neer分型：二部分骨折8例，三部分骨折15例，四部分骨折10例。受伤至手术时间1～7 d，平均3.67 d。术后肩关节功能采用Constant-Murley评分法进行评估。.
结果: 术后出现伤口感染2例，脂肪液化2例，均经相应处理后愈合；其余患者切口均Ⅰ期愈合。5例术后出现疼痛。33例均获随访，随访时间11～47个月，平均33个月。X线片示骨折均愈合，愈合时间5～9个月，平均7.5个月。术后发生肱骨头坏死2例，均为Neer四部分骨折，无明显症状；内固定失效3例（螺钉断裂2例、钢板断裂1例；Neer三部分骨折1例、四部分骨折2例），经保守治疗骨折均愈合。末次随访时Constant-Murley评分为42～90分，平均70.5分；优3例，良21例，中6例，差3例。.
结论: 选择合适的手术指征并早期功能锻炼，应用肱骨近端内固定锁定系统治疗复杂肱骨近端骨折可取得满意的临床疗效。.
Keywords: Internal fixation; Proximal humeral internal locking system plate; Proximal humerus fracture.