CAJ | 학술논문

目的探讨切开解剖复位、解剖锁定钢板内固定治疗肱骨近端三、四部分骨折脱位的疗效. 方法选择2004年9月-2007年12月行切开复位解剖锁定钢板内固定治疗的30例肱骨近端Neer三、四部分骨折脱位患者.随访资料完整的患者20例,应用肱骨近端锁定钢板(locking proximal humerus plate,LPHP)7例,肱骨近端内固定锁定系统(proximal humeral internal locking system,PHILOS)13例.术后早期指导患者进行肩关节被动功能锻炼. 结果随访36 ～ 71个月,平均51个月.随访期限内出现肱骨头坏死6例,内固定松动2例,螺钉穿出6例,骨折不愈合2例,感染2例,肱骨头坏死发生率为30％.疼痛视觉模拟评分(VAS)平均为2.55分.Constant肩关节评分平均为80.8分.按Neer肩关节功能评分标准:优8例,良6例,中3例,差3例,优良率为70％. 结论尽管切开复位解剖锁定钢板内固定术治疗肱骨近端三、四部分骨折脱位有较高的肱骨头缺血坏死发生率,尤其是65岁以上老年患者,但肱骨头坏死与肩关节功能之间无明显相关性,可根据患者个体情况有选择地采用此方法.
목적 탐토절개해부복위、해부쇄정강판내고정치료굉골근단삼、사부분골절탈위적료효. 방법 선택2004년9월-2007년12월행절개복위해부쇄정강판내고정치료적30례굉골근단Neer삼、사부분골절탈위환자.수방자료완정적환자20례,응용굉골근단쇄정강판(locking proximal humerus plate,LPHP)7례,굉골근단내고정쇄정계통(proximal humeral internal locking system,PHILOS)13례.술후조기지도환자진행견관절피동공능단련. 결과 수방36 ～ 71개월,평균51개월.수방기한내출현굉골두배사6례,내고정송동2례,라정천출6례,골절불유합2례,감염2례,굉골두배사발생솔위30％.동통시각모의평분(VAS)평균위2.55분.Constant견관절평분평균위80.8분.안Neer견관절공능평분표준:우8례,량6례,중3례,차3례,우량솔위70％. 결론 진관절개복위해부쇄정강판내고정술치료굉골근단삼、사부분골절탈위유교고적굉골두결혈배사발생솔,우기시65세이상노년환자,단굉골두배사여견관절공능지간무명현상관성,가근거환자개체정황유선택지채용차방법.
Objective To analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus. Methods The study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.Conclusions Although the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients.