CAJ | 학술논문

目的分析锁定钢板与人工肱骨头置换治疗肱骨近端三、四部分骨折的临床疗效.方法选择2006年6月-2010年6月手术治疗的63例(年龄＞55岁)肱骨近端三、四部分骨折的患者.采用切开复位锁定钢板内固定(钢板组)36例,人工肱骨头置换治疗(置换组)27例. 结果术后平均随访19.7个月,钢板组并发症发生率为28％,内翻畸形愈合、腋神经损伤、肱骨头坏死、异位骨化各1例,撞击综合征4例.置换组并发症发生率为24％,大结节不愈合2例,大结节移位消失、撞击综合征、肩关节半脱位各1例.钢板组三部分骨折Constant- Murtey评分优于置换组(P＜0.05).手术时间、出血量、疼痛视觉模拟评分( visual analog scale,VAS)两组差异无统计学意义.四部分骨折Constant - Murley评分和VAS评分两组差异无统计学意义,而手术时间、出血量置换组少于钢板组(P＜0.05). 结论锁定钢板与人工肱骨头置换均是治疗肱骨近端三、四部分骨折的有效手术方式.对患者年龄、骨的质量、骨折类型、粉碎程度及肱骨头坏死可能性的判断对手术方式的选择至关重要.
목적 분석쇄정강판여인공굉골두치환치료굉골근단삼、사부분골절적림상료효.방법 선택2006년6월-2010년6월수술치료적63례(년령＞55세)굉골근단삼、사부분골절적환자.채용절개복위쇄정강판내고정(강판조)36례,인공굉골두치환치료(치환조)27례. 결과 술후평균수방19.7개월,강판조병발증발생솔위28％,내번기형유합、액신경손상、굉골두배사、이위골화각1례,당격종합정4례.치환조병발증발생솔위24％,대결절불유합2례,대결절이위소실、당격종합정、견관절반탈위각1례.강판조삼부분골절Constant- Murtey평분우우치환조(P＜0.05).수술시간、출혈량、동통시각모의평분( visual analog scale,VAS)량조차이무통계학의의.사부분골절Constant - Murley평분화VAS평분량조차이무통계학의의,이수술시간、출혈량치환조소우강판조(P＜0.05). 결론 쇄정강판여인공굉골두치환균시치료굉골근단삼、사부분골절적유효수술방식.대환자년령、골적질량、골절류형、분쇄정도급굉골두배사가능성적판단대수술방식적선택지관중요.
Objective To analyze the clinical outcome of locking plate and hemiarthroplasty in treatment of Neer three- and four-part proximal humeral fractures. Methods A totalof 63 consecutive patients aged over 55 years with Neer three- and four-part proximal humeral fractures were treated surgically from June 2006 to June 2010.In the retrospective study,36 patients were treated by open reduction and locking plate fixation ( locking plate fixation group) and 27 patients treated by hemiarthroplasty (hemiarthroplasty group).Clinical outcomes including operation time,blood loss,visual analog scale ( VAS),Constant-Murley score and complications were evaluated. Results The average 19.7 months follow-up showed complication rate of 28％ in the locking plate group,including one patient with varss malunion,one with axillary nerve injury,one with humeral head necrosis,one with heterotopie calcification and four with impingement syndrome.The complication rate was 24％ in the hemiarthroplasty group,including two patients with tuberosity nonunion,one with tuberosity migration,one with impingement syndrome and one with joint semiluxation.The mean Constant-Murley score of three-part fractures in the locking plate group was ( 76.5 ±5.8) points,better than (69.2 ±7.2) points in the hemiarthroplasty group (P ＜0.05 ).While the two groups showed no significant differences with regards to operation time,blood loss and visual analog scale (VAS).As for the four-part fractures,the mean operation time was shorter and the mean blood loss was less in the hemiarthroplasty group compared with the locking plate group (P ＜0.05),while there were no obvious differences in VAS score and Constant-Murley score between the two groups. Conclusions Both locking plate and hemiarthroplasty are the reliable methods for the three- and four-part proximal humeral fractures.The patients' age,bone quality,fracture type,comminution degree and evaluation of osteonecrosis possibility,are critical for surgery decision.