CAJ | 학술논문

目的探讨人工半肩关节置换治疗肱骨近端粉碎骨折的疗效及影响因素.方法对2000年6月至2006年12月采用半肩关节置换治疗的34例肱骨近端粉碎骨折的患者资料进行回顾性研究.除1例为陈旧性骨折外,其余33例均为新鲜骨折.骨折根据Neer分型:三部分骨折6例,三部分骨折伴肩关节脱位4例,四部分骨折18例,四部分骨折伴肩关节脱位3例,肱骨头劈裂性骨折3例.随访采用Neer评分和视觉模拟(VAS)评分,分析年龄、大小结节重建方法、骨折类型、大小结节愈合质量对肩关节主动上举、主动外旋、Neer评分、VAS评分的影响.结果所有患者获3～5年(平均3.6年)随访,28例无肩痛,5例偶有轻微肩痛,1例有中度肩痛.Neer评分:优14例,良12例,可7例,差1例,优良率为76.5%;肩关节活动范围平均为:上举100°,外旋30°,内旋L5水平;VAS评分平均3.1分.70岁以下年龄组和70岁以上年龄组在肩关节主动上举活动范围平均值和Neer评分平均值比较差异均有统计学意义(P＜0.05),解剖重建和重叠重建大小结节两组患者的各项指标比较差异均无统计学意义(P＞0.05),不同骨折类型组患者的各项指标比较差异均无统计学意义(P＞0.05),大小结节完全愈合组和大小结节愈合不良或吸收组的肩关节主动上举活动范围平均值比较差异有统计学意义(P=0.003).结论人工半肩关节置换术治疗肱骨近端严重粉碎性骨折,疗效满意,但应严格掌握适应证.大小结节重建的质量、患者年龄、手术技巧等可以影响疗效.
목적 탐토인공반견관절치환치료굉골근단분쇄골절적료효급영향인소.방법 대2000년6월지2006년12월채용반견관절치환치료적34례굉골근단분쇄골절적환자자료진행회고성연구.제1례위진구성골절외,기여33례균위신선골절.골절근거Neer분형:삼부분골절6례,삼부분골절반견관절탈위4례,사부분골절18례,사부분골절반견관절탈위3례,굉골두벽렬성골절3례.수방채용Neer평분화시각모의(VAS)평분,분석년령、대소결절중건방법、골절류형、대소결절유합질량대견관절주동상거、주동외선、Neer평분、VAS평분적영향.결과 소유환자획3～5년(평균3.6년)수방,28례무견통,5례우유경미견통,1례유중도견통.Neer평분:우14례,량12례,가7례,차1례,우량솔위76.5%;견관절활동범위평균위:상거100°,외선30°,내선L5수평;VAS평분평균3.1분.70세이하년령조화70세이상년령조재견관절주동상거활동범위평균치화Neer평분평균치비교차이균유통계학의의(P＜0.05),해부중건화중첩중건대소결절량조환자적각항지표비교차이균무통계학의의(P＞0.05),불동골절류형조환자적각항지표비교차이균무통계학의의(P＞0.05),대소결절완전유합조화대소결절유합불량혹흡수조적견관절주동상거활동범위평균치비교차이유통계학의의(P=0.003).결론 인공반견관절치환술치료굉골근단엄중분쇄성골절,료효만의,단응엄격장악괄응증.대소결절중건적질량、환자년령、수술기교등가이영향료효.
Objective To investigate the outcome and affecting factors of the treatment of proximal humerus comminuted fractures with the semi-shoulder arthroplasty. Methods We reviewed 34 patients who had undergone hemiarthroplasty of shoulder between June 2000 and December 2006 for treatment of their comminuted fracture of proximal humerus. All but one fracture were fresh. By Neer classification, 6 cases were three-part fractures, 4 three-part fractures plus shoulder dislocation, 18 four-part fractures, 3 four-part fractures plus shoulder dislocation, and 3 split fractures of humeral head. Neer scoring system was used for follow-up assessment. The effects of age, fracture type, reconstruction and union of tuberosities on active elevation, active external rotation, Neer scores and visual analogue scale(VAS) scores were analyzed. Results The patients were followed up for an average of 3. 6 years (3 to 5 years). Twenty-eight patients reported no shoulder pain, 5 experienced slight pain occasionally, and one had severe pain. The average active shoulder elevation was 110°,external rotation was 30° and internal rotation was at L5. By Neer scoring system, 14 cases were rated as excellent, 12 as good, 7 as fair and one as poor, with an excellent to good rate of 76. 5%. The patients' satisfactory rate was 90%. There were significant differences in active elevation and Neer scores between patients under 70 and patients above 70( P ＜ 0. 05) . There were no significant differences in all indexes between anatomic tuberosity reconstruction and overlapping tuberosity reconstruction( P ＞ 0. 05), as well as between different fracture types ( P ＞ 0. 05). There was a significant difference in active elevation between different union qualities( P = 0. 003) . Conclusions Hemiarthroplasty of shoulder can achieve good results for comminuted fractures of the proximal humerus. The quality of tuberosity reconstruction, quality of tuberosity union and age of the patient may be the main factors that may affect the treatment outcome.