CAJ | 학술논문

目的探讨手术治疗肱骨大结节移位骨折的要点和疗效. 方法回顾性分析2006年6月至2011年6月收治且获得随访的20例肱骨大结节移位骨折患者资料,男11例,女9例；年龄30～69岁,平均49.6岁.受伤至手术时间为1～122 d,平均8.2d.17例患者采用开放手术,2例采用关节镜手术,1例采用开放手术加关节镜手术；开放手术采用三角肌-胸大肌入路7例,经三角肌入路10例；骨折固定采用7种方法,以空心钉固定最多(11例).患肩功能采用加州大学洛杉矶分校(UCLA)肩关节功能评分系统进行评定. 结果 20例患者术后获6～51个月(平均13.6个月)随访.术后6周所有患者骨折均获愈合.末次随访时20例患者患肩功能采用UCLA肩关节功能评分系统评定:7例采用三角肌-胸大肌入路患者UCLA评分平均为28.4分,10例经三角肌入路患者UCLA评分平均为30.4分,2例关节镜手术患者UCLA评分平均为34.5分,1例开放手术加关节镜手术患者UCLA评分为34分；其中优10例,良3例,差7例,优良率为65.0％. 结论切开复位内固定是治疗肱骨大结节移位骨折的主要方法,手术入路多采用经三角肌入路.关节镜技术治疗单纯大结节骨折的适应证为骨折块不大、骨折线靠近近端、移位小及粉碎不严重者.
목적 탐토수술치료굉골대결절이위골절적요점화료효. 방법 회고성분석2006년6월지2011년6월수치차획득수방적20례굉골대결절이위골절환자자료,남11례,녀9례；년령30～69세,평균49.6세.수상지수술시간위1～122 d,평균8.2d.17례환자채용개방수술,2례채용관절경수술,1례채용개방수술가관절경수술；개방수술채용삼각기-흉대기입로7례,경삼각기입로10례；골절고정채용7충방법,이공심정고정최다(11례).환견공능채용가주대학락삼기분교(UCLA)견관절공능평분계통진행평정. 결과 20례환자술후획6～51개월(평균13.6개월)수방.술후6주소유환자골절균획유합.말차수방시20례환자환견공능채용UCLA견관절공능평분계통평정:7례채용삼각기-흉대기입로환자UCLA평분평균위28.4분,10례경삼각기입로환자UCLA평분평균위30.4분,2례관절경수술환자UCLA평분평균위34.5분,1례개방수술가관절경수술환자UCLA평분위34분；기중우10례,량3례,차7례,우량솔위65.0％. 결론 절개복위내고정시치료굉골대결절이위골절적주요방법,수술입로다채용경삼각기입로.관절경기술치료단순대결절골절적괄응증위골절괴불대、골절선고근근단、이위소급분쇄불엄중자.
Objective To discuss the techniques and efficacy of surgical treatment of displaced fractures of the humeral greater tuberosity. Methods We reviewed the 20 patients who had been treated and followed up for displaced fractures of the humeral greater tuberosity in our institute between June 2006 and June 2011.They were 11 men and 9 women,aged from 30 to 69 years(average,49.6 years).The time intervals from injury to surgery ranged from one to 122 days (average,8.2 days).(Open surgery was performed for 17 patients,arthroscopy for 2 and open surgery plus arthroscopy for one.In open surgery the deltopectoral approach was adopted for 7 patients and the trans-deltoid approach for 10.Of the 7 fixation methods adopted,the cannulated screws were the most frequently used (in 11 cases).The functional outcomes of the injured shoulders were evaluated by the University of California at Los Angeles (UCLA) shoulder rating system.Results The patients obtained a mean follow-up of 13.6 months (range,6 to 51 months).The fractures all united 6 weeks postoperatively.By the UCLA system,the 7 patients in whom the deltopectoral approach was adopted scored an average of 28.4 points,the 10 patients in whom the trans-deltoid approach was adopted scored an average of 30.4 points,the 2 patients undergoing arthroscopy scored an average of 34.5 points,and the one undergoing open surgery plus arthroscopy scored 34 points.Ten cases were rated as excellent,3 as good and 7 as poor,with a good to excellent rate of 65.0％. Conclusions Open reduction and internal fixation is the mainstay treatment of displaced fractures of the greater tuberosity of the humerus.The trans-deltoid approach may be the most frequently used.The methods of internal fixation varied depending on the characteristics of the fracture.The arthroscopic indications for fractures of greatertuberosity are moderate fragments,proximal fracture line,little displacement and little comminution.