桡骨远端骨折治疗的选择

目的：探讨不同类型的桡骨远端骨折的有效治疗方法。方法：分析106例桡骨远端骨折,分别采用闭合手法复位,切开复位或有限切开复位内固定方法,分别对骨折复位比较及功能评分。结果：完整随访106例桡骨远端骨折病例,随访时间3～21个月。对保守治疗组与手术治疗组进行骨折复位测定及改良Garland和Werley评分,A,B型骨折无显著性差异;C型骨折中,手术组明显优于保守治疗组。结论：对于C型骨折,建议行切开复位内固定治疗;对于A,B型需根据实际情况选择治疗方式。

Proximal Humeral Internal Locking System for Humeral Proximal Fractures of Elderly Patients

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 fix-ation 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 en-hances the treatment effect.PHILOS plate is especially suitable for osteoporosis and comminuted proximal humeral fractures of elderly patients.