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目的：探讨应用肱骨近端内锁定系统（PHILOS）治疗高龄肱骨近端骨折的方法及疗效。方法：2007 年10 月至2010 年02 月间，我院使用PHILOS内固定钢板治疗高龄肱骨近端骨折45例，男19例，女26例，年龄54～75岁，平均66 岁。根据Neer 分型，一部分骨折4例，二部分骨折6例，三部分骨折17例，四部分骨折18例。手术采用三角肌钝性劈开入路，保护附着于大骨折块和大、小结节上的软组织，骨折复位后均行PHILOS固定。患肩功能按Neer肩关节评分系统进行评价。结果：本组随访时间10～24 个月，平均16个月。骨折均愈合，平均愈合时间3个月。患侧肩关节评分优28例，良12例，可3 例，差2例，优良率为88.9％。结论：PHILOS钢板可牢固固定高龄患者骨折，使骨折愈合与功能恢复相同步，适于粉碎性骨折和肱骨近端骨质疏松骨折的治疗。

英文摘要:

Objective: To investigate the clinical effect of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures of elderly patients. Methods: Forty-five cases of proximal humeral fractures of elderly treated with PHILOS from Oct. 2007 to Feb. 2010 were studied retrospectively, in which nineteen males and twenty-six females with age of 54 to 75 years old (mean 66 years). According to Neer classification, four cases with one-part fractures, six cases with two-part fractures, seventeen cases with three-part fractures and eighteen cases with four-part fractures. Reduction and fixation was done via modified approach, without peeling the soft tissues of the greater and lesser tuberosity. All the cases accepted the treatment of PHILOS plate internal fixation. Assessment was done using the Neer scoring system. Results: The follow up period was 10 to 24 months (mean 16 months) and it showed that all fractures were healed with average union period of 3 months. According to the Neer scoring system, there were 28 excellent cases,12 good cases,3 fair cases and 2 bad cases. The excellent and good rate was 88.9%. Conclusion: PHILOS system can firmly fixate the fractures. It simultaneously carries out fracture healing and function exercise and enhances the treatment effect. PHILOS plate is especially suitable for osteoporosis and comminuted proximal humeral fractures of elderly patients.

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