CAJ | 학술논문

目的测量肱骨颈干角的正常值,探讨成人肱骨近端骨折锁定钢板固定术中重建肱骨颈干角的临床意义.方法测量382名正常成人的肱骨颈干角.回顾性分析2006年6月至2011年2月采用锁定钢板治疗的128例肱骨近端骨折患者的病历资料.测量术后患侧肱骨颈干角,并以测得的正常成人肱骨颈干角双侧95％参考值范围作为参考值,将患者分为内翻复位组(颈干角＜双侧95％参考值范围下限),正常重建组(颈干角位于双侧95％参考值范围内)和外翻复位组(颈干角＞双侧95％参考值范围上限).随访指标包括患侧肱骨颈干角的变化、肩关节Constant评分、疼痛视觉模拟评分(visual analog scale,VAS)及并发症等.结果国人肱骨颈干角的正常值为136.1°±4.5°,双侧95％参考值范围127.2°～144.9°.所有患者获得6～32个月的随访,平均13.8个月.内翻复位组29例、正常重建组90例、外翻复位组9例.末次随访,Constant评分分别平均为70.3分、77.2分和73.2分,VAS评分分别平均为2.8分、1.8分和2.1分,肱骨头内翻角度分别平均为4.2°、1.6°和3.1°,并发症发生率分别为34.5％、14.4％和22.2％.正常重建组在功能恢复、VAS评分、术后肱骨头内翻情况及并发症发生率等方面均优于内翻复位组.结论术中重建良好的肱骨颈干角是内固定稳定、预防术后肱骨头内翻、内固定失败和取得良好临床疗效的关键.肱骨头内翻复位易导致肱骨头进行性内翻及其相关并发症.
목적 측량굉골경간각적정상치,탐토성인굉골근단골절쇄정강판고정술중중건굉골경간각적림상의의.방법 측량382명정상성인적굉골경간각.회고성분석2006년6월지2011년2월채용쇄정강판치료적128례굉골근단골절환자적병력자료.측량술후환측굉골경간각,병이측득적정상성인굉골경간각쌍측95％삼고치범위작위삼고치,장환자분위내번복위조(경간각＜쌍측95％삼고치범위하한),정상중건조(경간각위우쌍측95％삼고치범위내)화외번복위조(경간각＞쌍측95％삼고치범위상한).수방지표포괄환측굉골경간각적변화、견관절Constant평분、동통시각모의평분(visual analog scale,VAS)급병발증등.결과 국인굉골경간각적정상치위136.1°±4.5°,쌍측95％삼고치범위127.2°～144.9°.소유환자획득6～32개월적수방,평균13.8개월.내번복위조29례、정상중건조90례、외번복위조9례.말차수방,Constant평분분별평균위70.3분、77.2분화73.2분,VAS평분분별평균위2.8분、1.8분화2.1분,굉골두내번각도분별평균위4.2°、1.6°화3.1°,병발증발생솔분별위34.5％、14.4％화22.2％.정상중건조재공능회복、VAS평분、술후굉골두내번정황급병발증발생솔등방면균우우내번복위조.결론 술중중건량호적굉골경간각시내고정은정、예방술후굉골두내번、내고정실패화취득량호림상료효적관건.굉골두내번복위역도치굉골두진행성내번급기상관병발증.
Objective To investigate the normal humeral neck-shaft angle (NSA) and the clinical benefits of reconstructing normal NSA for displaced proximal humerus fractures treated with locking plates.Methods Humeral NSA was measured in 382 normal adults.A retrospective analysis was conducted on 128 patients with proximal humerus fractures treated with locking plates from June 2006 to February 2011.The postoperative NSA of the affected shoulders was measured,and all cases were divided into 3 groups based on bilateral 95％ reference range of the normal NSA: varus group in which the postoperative NSA was smaller than the lower limit of the bilateral 95％ reference range,normal group in which the postoperative NSA was within the bilateral 95％ reference range,and valgus group in which the postoperative NSA was larger than the upper limit of the bilateral 95％ reference range.The changes of the NSA,Constant shoulder scores,visual analog scale (VAS) score and complications were documented for analysis.Results The mean normal NSA was 136.1°± 4.5 °and the bilateral 95％ reference range was 127.2 ° to 144.9 °.All patients were followed up for 6 to 32 months.There were 29 patients in varus group,90 in normal group and 9 in valgus group.For the 3 groups,at final follow-up,the mean Constant shoulder score was 70.3,77.2 and 73.2,respectively; the mean VAS score was 2.8,1.8 and 2.1,respectively; the mean varus angle was 4.2°,1.6° and 3.1°,respectively; and the incidence of complications was 34.5％,14.4％ and 22.2％,respectively.The results of the normal group were better than those of varus group in terms of Constant shoulder score,VAS score,and incidence of complications.Conclusion Reconstruction of the normal NSA is crucial to the good clinical outcomes.Patients with initial varus malreduction have a higher incidence of complications,such as secondary loss of reduction.