CAJ | 학술논문

目的：探讨应用经皮微创钢板接骨技术（MIPPO）加植骨治疗老年肱骨近端Neer三、四部分骨折的临床效果。方法经三角肌前外侧入路，MIPPO技术加植骨治疗38例老年肱骨近端Neer三、四部分骨折（三部分骨折32例，四部分骨折6例）。观察肩关节活动范围、肌力、疼痛情况，肩关节功能采用Con-stant-Murley肩关节评分评定疗效。结果术后随访12～36个月，平均19.2个月，所有患者骨折均愈合，平均愈合时间16.3周。无伤口感染，无钢板螺钉断裂和内固定松动，肱骨头坏死1例。术后功能根据Con-stant-Murley肩关节评分，优27例，良7例，可4例；优良率为89.5％。结论MIPPO技术加植骨老年肱骨近端Neer三、四部分骨折体现间接复位、微创、生物学固定理念，是一种可靠、有效的治疗方法。
목적：탐토응용경피미창강판접골기술（MIPPO）가식골치료노년굉골근단Neer삼、사부분골절적림상효과。방법경삼각기전외측입로，MIPPO기술가식골치료38례노년굉골근단Neer삼、사부분골절（삼부분골절32례，사부분골절6례）。관찰견관절활동범위、기력、동통정황，견관절공능채용Con-stant-Murley견관절평분평정료효。결과술후수방12～36개월，평균19.2개월，소유환자골절균유합，평균유합시간16.3주。무상구감염，무강판라정단렬화내고정송동，굉골두배사1례。술후공능근거Con-stant-Murley견관절평분，우27례，량7례，가4례；우량솔위89.5％。결론MIPPO기술가식골노년굉골근단Neer삼、사부분골절체현간접복위、미창、생물학고정이념，시일충가고、유효적치료방법。
Objective To explore the clinical significance of minimally invasive percutaneous plate osteo-synthesis (MIPPO) techniques combined with bone grafting in treating Neer three-part or four-part proximal humeral fractures in elderly patients.Methods A total of 38 elderly patients with proximal humeral fractures were treated with MIPPO techniques combined with bone grafting by the anterior-lateral deltoid approach.According to the Neer classification,32 cases were three-part fractures and 6 cases were four-part fractures.The shoulder joint activity, muscle strength,pain degree of the 38 patients were observed and their shoulder functions were evaluated by the Constant-Murley scoring system.Results The follow up period ranged from 12 to 36 months ( averaging 19.2 months).Bone union was achieved in all the cases ,and the average time for bony union was 16.3 weeks.There was no infection,no screw or plate breakage and no fixation loosening .There was 1 case of avascular necrosis of the humeral head.Postoperative shoulder function scores evaluated by Constant-Murley scoring system showed excellent in 27 cases,good in 7 cases and fair in 4 cases.The excellent and good rate was 89.5%.Conclusion MIPPO techniques combined with bone grafting for treating Neer three-part or four-part proximal humeral fractures in the elderly patients is a kind of reliable and effective treatment method ,which follows the principles of indirect reduc-tion,minimal invasiveness and biological fixation .