Objective: To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture.
Methods: The clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up.
Results: The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation ( P<0.05).
Conclusion: PHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.
目的: 探讨肱骨近端锁定内固定系统（proximal humerus internal locking system，PHILOS）钢板结合肩袖加强缝合治疗肱骨近端Neer Ⅳ型骨折的临床效果。.
方法: 回顾分析2016年1月—2020年12月收治的48例肱骨近端骨折患者临床资料，其中男18例，女30例；年龄28～69岁，平均56.3岁。致伤原因：摔伤39例，交通事故伤9例。受伤至手术时间2～5 d，平均2.8 d。均为完全移位的肱骨近端Neer Ⅳ型粉碎骨折，其中合并脱位11例。患者均在解剖复位大结节后，用PHILOS钢板行内固定，然后将肩袖缝合于钢板上以加强固定。记录手术时间，观察切口愈合、骨折愈合及并发症发生情况。术前、术后3个月、末次随访时采用疼痛视觉模拟评分（VAS）、Constant-Murley肩关节评分、美国加州大学洛杉矶分校（UCLA）评分、美国肩肘外科协会（ASES）评分评估肩关节功能。.
结果: 手术时间65～90 min，平均76.9 min。术后切口均Ⅰ期愈合。48例均获随访，随访时间9～16个月，平均12个月。骨折复位良好并且均正常愈合，愈合时间2～6个月，平均4.6个月。随访期间患者均未出现肩峰下撞击、骨块再移位、螺钉切出等并发症；1例患者发生肱骨头坏死，但肩关节基本功能尚可，症状较轻，未行处理。术后3个月患者基本恢复上肢功能，术后3个月及末次随访时VAS评分、Constant-Murley评分、UCLA评分、ASES评分均较术前显著改善，末次随访时较术后3个月进一步改善，差异均有统计学意义（ P<0.05）。.
结论: PHILOS钢板结合肩袖加强缝合治疗肱骨近端Neer Ⅳ型骨折，有利于患者术后早期康复功能锻炼，提高术后肩关节功能，减少并发症的发生。.
Keywords: Proximal humeral fracture; greater tuberosity of humerus; internal fixation; rotator cuff.