CAJ | 학술논문

目的探讨肱骨前方入路结合锁定加压接骨板微创治疗肱骨二或三部分骨折的疗效. 方法 2005年3月至2008年10月,经肱骨前方入路应用锁定加压钢板(LCP)或肱骨近端内固定系统(PHILOS)钢板微创治疗22例肱骨二或三部分骨折患者,男13例,女9例;年龄46～78岁,平均63.4岁);左侧7例,右侧14例.骨折类型:肱骨干骨折伴肱骨近端骨折11例,肱骨干骨折伴肱骨远端骨折8例,肱骨干骨折伴肱骨近端骨折及肩关节脱位2例,肱骨干骨折合并肱骨近端、远端骨折及肩关节脱位1例.其中2例术前伴桡神经损伤,急诊行桡神经探查后再复位固定骨折.记录手术时间及术中出血量.采用Neer肩关节评分标准及肘关节HSS评分标准分别对患者患侧肩关节和肘关节进行评分.结果评价以1年为标准,其中1例患者术后随访不到1年,以随访终末时间为结点. 结果 22例患者的手术时间78～150 min,平均107.9 min;术中出血量110～450 mL,平均274 mL.20例术后获平均9.4个月(8～22个月)随访,2例失访.20例患者骨折均获愈合,愈合时间8～16周(平均11.5周).骨折端无移位,螺钉无松动、拔出及断钉发生.2例术前伴桡神经损伤患者,1例3 d后功能恢复,另1例4个月后功能恢复.肩关节功能按Neer评分标准评定:优12例,良5例,中3例,优良率为85.0%.肘关节功能按HSS评分标准评定:优16例,良4例,优良率100%. 结论肱骨前方切口经皮置入锁定加压接骨板具有创伤小、不损伤腋神经及桡神经等优点,治疗肱骨二或三部分骨折可获得较理想的临床疗效.
목적 탐토굉골전방입로결합쇄정가압접골판미창치료굉골이혹삼부분골절적료효. 방법 2005년3월지2008년10월,경굉골전방입로응용쇄정가압강판(LCP)혹굉골근단내고정계통(PHILOS)강판미창치료22례굉골이혹삼부분골절환자,남13례,녀9례;년령46～78세,평균63.4세);좌측7례,우측14례.골절류형:굉골간골절반굉골근단골절11례,굉골간골절반굉골원단골절8례,굉골간골절반굉골근단골절급견관절탈위2례,굉골간골절합병굉골근단、원단골절급견관절탈위1례.기중2례술전반뇨신경손상,급진행뇨신경탐사후재복위고정골절.기록수술시간급술중출혈량.채용Neer견관절평분표준급주관절HSS평분표준분별대환자환측견관절화주관절진행평분.결과 평개이1년위표준,기중1례환자술후수방불도1년,이수방종말시간위결점. 결과 22례환자적수술시간78～150 min,평균107.9 min;술중출혈량110～450 mL,평균274 mL.20례술후획평균9.4개월(8～22개월)수방,2례실방.20례환자골절균획유합,유합시간8～16주(평균11.5주).골절단무이위,라정무송동、발출급단정발생.2례술전반뇨신경손상환자,1례3 d후공능회복,령1례4개월후공능회복.견관절공능안Neer평분표준평정:우12례,량5례,중3례,우량솔위85.0%.주관절공능안HSS평분표준평정:우16례,량4례,우량솔100%. 결론 굉골전방절구경피치입쇄정가압접골판구유창상소、불손상액신경급뇨신경등우점,치료굉골이혹삼부분골절가획득교이상적림상료효.
Objective To investigate the efficacy of minimally invasive treatment of humeral multi-fractures with a locking compression plate through the anterior humeral approach. Methods From March 2005 to October 2008, 22 cases of unstable humeral multi-fractures were treated by the above method.Of them, 12 were injured in a traffic accident and 10 in daily life. There were 13 males and 9 females, with a mean age of 63.4 (ranging from 46 to 78) years. The left side was involved in 7cases, and the right side was involved in 14 cases. According to X-rays, 11 were fractures of humeral shaft and proximal humerus, 8 were fractures of humeral shaft and distal humerus, 2 were fractures of humeral shaft and proximal humerus and shoulder dislocation, and one case was fractures of humeral shaft, proximal and distal humerus and shoulder dislocation. Of them, 2 had emergency treatment of the injured radial nerve and internal fixation with Philos plate. Results The mean operative time was 107.9 min(range, 78 ～ 150 min ), and operative blood loss was 274 mL (range, 110 ～ 450 mL). In this group, 20 patients were followed up for 8 to 22 (average, 9. 4)months. All these patients had bone healing in 8 to 16 (average, 11.5) weeks. By Neer evaluation system,12 cases were rated as excellent, 5 as good, and 3 as fine, with the excellent-to-good rate being 85.0%. The function of elbow was rated by HSS as excellent in 16 cases and good in 4, with the excellent-to-good rate being 100%. Conclusion Minimally invasive treatment with a locking compression plate through anterior humeral approach is an effective and safe method for treating the humeral multi-fractures.