CAJ | 학술논문

目的：探讨肱骨近端锁定钢板( locking proximal humerus plate，LPHP )结合深冻同种异体腓骨头髓腔内植入治疗老年粉碎性肱骨近端骨折的疗效。方法2010年1月至2012年6月，采用LPHP结合深冻同种异体腓骨头髓腔内植入治疗15例老年粉碎性肱骨近端骨折。其中男6例，女9例，年龄62～85岁，平均73岁。致伤原因：摔伤11例，交通事故4例。所有患者均有骨质疏松，骨折均为粉碎性，内侧壁均缺少支撑，复位比较困难；Neer分型：三部分骨折7例，四部分骨折8例，其中骨折伴肩关节脱位4例。结果手术时间60～180 min，平均95 min；术中出血量100～500 ml，平均240 ml。患者术后伤口均一期愈合，无免疫排斥反应，无感染、血管及神经损伤等早期并发症发生。所有患者随访15～30个月，平均19个月。X 线片检查示骨折均获得骨性愈合，未见明显复位丢失和骨折再移位，未见螺钉固定失效或切出，未见肱骨头坏死。术后12个月患肢肩关节功能按照Neer评分系统进行评价，优良13例，可2例，优良率为86.7%。结论LPHP结合同种异体腓骨头髓腔植入治疗老年粉碎性肱骨近端骨折疗效满意。
목적：탐토굉골근단쇄정강판( locking proximal humerus plate，LPHP )결합심동동충이체비골두수강내식입치료노년분쇄성굉골근단골절적료효。방법2010년1월지2012년6월，채용LPHP결합심동동충이체비골두수강내식입치료15례노년분쇄성굉골근단골절。기중남6례，녀9례，년령62～85세，평균73세。치상원인：솔상11례，교통사고4례。소유환자균유골질소송，골절균위분쇄성，내측벽균결소지탱，복위비교곤난；Neer분형：삼부분골절7례，사부분골절8례，기중골절반견관절탈위4례。결과수술시간60～180 min，평균95 min；술중출혈량100～500 ml，평균240 ml。환자술후상구균일기유합，무면역배척반응，무감염、혈관급신경손상등조기병발증발생。소유환자수방15～30개월，평균19개월。X 선편검사시골절균획득골성유합，미견명현복위주실화골절재이위，미견라정고정실효혹절출，미견굉골두배사。술후12개월환지견관절공능안조Neer평분계통진행평개，우량13례，가2례，우량솔위86.7%。결론LPHP결합동충이체비골두수강식입치료노년분쇄성굉골근단골절료효만의。
Objective To investigate the effects of a deep-frozen intramedullary fibular head allograft together with a locking proximal humerus plate ( LPHP ) fixation in the treatment of comminuted fractures of the proximal humerus in elderly patients. Methods From January 2010 to June 2012, 15 elderly patients with comminuted fractures of the proximal humerus were treated with a LPHP together with a deep-frozen intramedullary ifbular head allograft. There were 6 males and 9 females, whose mean age was 73 years old ( range;62-85 years ). Fractures were caused by falling in 11 cases and trafifc accidents in 4 cases. All patients had osteoporosis and comminuted fractures, with loss of the medial column mechanical support. As a result, the reduction was relatively dififcult. According to the Neer classiifcation, 7 patients had 3-part fractures and 8 patients had 4-part fractures. Fractures combined with shoulder dislocation occurred in 4 cases. Results The operation time was 60-180 minutes with an average period of 95 minutes. The blood loss was 100-500 ml during the operation with an average amount of 240 ml. All incisions healed by ifrst intention postoperatively, and no early complications such as immunological rejection, infection or neurovascular injuries were found. All patients were followed up for 19 months on average ( range;15-30 months ). Based on the X-ray iflms, all fractures got union, without obvious loss of reduction or fracture displacement, screw ifxation failure or cut-out or humeral head necrosis. According to the Neer shoulder function scoring system, the results were excellent in 13 cases and fair in 2 cases at 1 year after the operation. The excellent and good rate was 86.7%. Conclusions The effects of a deep-frozen intramedullary ifbular head allograft together with a LPHP ifxation were satisfactory in the treatment of comminuted fractures of the proximal humerus in elderly patients.