Application of minimally invasive locking compression plate in treatment of proximal humeral fractures

Abstract

OBJECTIVE: To evaluate the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) in the treatment of proximal humeral shaft fracture. METHODS: From July 2004 to April 2008, 26 patients with displaced fractures of the proximal humeral shaft were recruited, including 8 males and 18 females. Age of patients averaged 66 years old (range, 34-82 years old). According to AO classification, there were 4 cases of type A1, 2 cases of type A2, 8 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1 and 2 cases of type C2. The time from injury to surgery averaged 2 days (range, 1-5 days). There were 8 osteoporotic fractures. RESULTS: All surgical wound healed primarily, and there was no wound infection. Three patients had postoperative radial nerve neurapraxia, which recovered at 4, 6, 8 months respectively. All patients were followed up for 6-24 months with an average of 14.1 months. Radiological examination revealed bony union within 6 months in 25 cases. There was 1 delayed union which remained asymptomatic and eventually healed at 8 months with acceptable Constant-Murley score. There were 3 cases of shoulder impingement syndrome diagnosed at 3 months post-operatively. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant-Murley scoring system, there were 11 excellent, 10 good and 5 acceptable results. The excellent or good rate was 80.8%. CONCLUSION: MIPO technique using LCP is an effective method to treat proximal humeral shaft fractures, which facilitates functional recovery of the shoulder joint. During the surgery, it is important to achieve a good fracture reduction and to avoid complications.

目的總結採用微創接骨板固定(minimally invasive plate osteosynthesis,MIPO)技術植入鎖定加壓鋼板(locking compression plate,LCP)治療肱骨幹近端骨折的臨床效果。方法2004年7月-2008年4月,採用MIPO技術植入LCP治療26例肱骨幹近端1/3移位骨折患者。其中男8例,女18例;年齡34～82歲,平均66歲。骨折按AO分型,A1型4例,A2型2例,B1型8例,B2型4例,B3型2例,C1型4例,C2型2例。合併骨質疏鬆8例。受傷至手術時間1～5d,平均2d。結果術後患者切口均Ⅰ期癒合,無感染等並發癥發生。 3例術後合併橈神經功能性麻痺,分別於術後4、6、8個月自行恢復。 26例均獲隨訪,隨訪時間6～24個月,平均14.1個月。 X線片示25例於術後6個月內骨折達骨性癒合;1例因內固定松動發生延遲癒合,但無臨床癥狀,於術後8個月骨折癒合,功能恢復至可。術後3個月3例發生肩關節撞擊徵,取出內固定行功能鍛煉後功能恢復至可。採用Constant-Murley評分方法評定療效,優11例,良10例,可5例,優良率80.8%。結論採用MIPO技術植入LCP治療肱骨近端骨折是一種合理可行的方法,有利於肩關節早期功能恢復,術中應重視骨折復位和避免並發癥的發生。