CAJ | 학술논문

目的探讨肱骨近端Neer四部分骨折半肩置换术中有效的软组织重建和平衡方法 ,避免术后肩关节不稳定、大结节移位等并发症.方法 2002年6月至2006年6月,肱骨近端四部分骨折患者25例,其中男性10例,女性15例,年龄56-80岁,平均66岁,均行人工肱骨头置换术.采用改良的手术入路和软组织重建、平衡技术修复肩关节.结果术后25例患者均获随访,随访时间1～4.5年,平均2.3年.无肩关节感染、神经损伤、假体松动.2例术后患肢置外展架者出现肩关节向前下方脱位和半脱位;1例主动外展活动过早出现假体向上移位,但无不适;其余病例无明显肩关节不稳定及大结节移位或愈合不良.按Neer评分标准肩关节评分75～92分,平均87.5分;优6例,良15例,可4例,优良率84%.结论肱骨近端四部分骨折半肩置换术中采用改良的手术入路和软组织重建平衡技术结合有效的康复锻炼可以防止术后肩关节不稳定和大结节移位、愈合不良等并发症,有利于患者恢复肩部功能.
목적 탐토굉골근단Neer사부분골절반견치환술중유효적연조직중건화평형방법 ,피면술후견관절불은정、대결절이위등병발증.방법 2002년6월지2006년6월,굉골근단사부분골절환자25례,기중남성10례,녀성15례,년령56-80세,평균66세,균행인공굉골두치환술.채용개량적수술입로화연조직중건、평형기술수복견관절.결과 술후25례환자균획수방,수방시간1～4.5년,평균2.3년.무견관절감염、신경손상、가체송동.2례술후환지치외전가자출현견관절향전하방탈위화반탈위;1례주동외전활동과조출현가체향상이위,단무불괄;기여병례무명현견관절불은정급대결절이위혹유합불량.안Neer평분표준견관절평분75～92분,평균87.5분;우6례,량15례,가4례,우량솔84%.결론 굉골근단사부분골절반견치환술중채용개량적수술입로화연조직중건평형기술결합유효적강복단련가이방지술후견관절불은정화대결절이위、유합불량등병발증,유리우환자회복견부공능.
Objective To explore the effective skills of reconstruction and balance of soft tissure in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement. Methods From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint repairation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue. Results The mean duration of follow-up was 2.3 years(ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or semiluxation occured due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%. Conclusion In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.