CAJ | 학술논문

目的：探讨肩峰下经三角肌外侧分离入路，运用肱骨近端锁定钢板结合MIPPO技术微创治疗肱骨近端骨折的治疗效果。方法：2009年4月至2012年3月对26例闭合性肱骨近端骨折患者采用三角肌外侧入路应用锁定钢板进行骨折固定，其中男17例，女9例；年龄28～76岁，平均58岁。骨折类型按照Neer分型：2部分骨折7例，3部分骨折15例，4部分骨折4例。受伤至手术时间3～10 d，平均5．6 d。术后对骨折愈合时间、并发症情况和肩关节功能（Neer肩关节功能评分标准）进行评价。结果：26例均获随访，时间10～21个月，平均13．6个月。骨折均愈合，平均愈合时间12．5周（10～21周）。未发生肱骨头坏死和腋神经损伤等并发症。根据Neer评分，总分（88．36±7．82）分，其中疼痛（30．82±3．24）分，功能（23．76±5．71）分，活动度（17．59±5．36）分，解剖位置（7．03±2．39）分；结果优18例，良5例，可2例，差1例。结论：应用肩峰下经三角肌分离入路运用近端锁定钢板微创治疗肱骨近端骨折，具有创伤小、出血少、固定可靠、骨折愈合率高、功能恢复好等优点。
목적：탐토견봉하경삼각기외측분리입로，운용굉골근단쇄정강판결합MIPPO기술미창치료굉골근단골절적치료효과。방법：2009년4월지2012년3월대26례폐합성굉골근단골절환자채용삼각기외측입로응용쇄정강판진행골절고정，기중남17례，녀9례；년령28～76세，평균58세。골절류형안조Neer분형：2부분골절7례，3부분골절15례，4부분골절4례。수상지수술시간3～10 d，평균5．6 d。술후대골절유합시간、병발증정황화견관절공능（Neer견관절공능평분표준）진행평개。결과：26례균획수방，시간10～21개월，평균13．6개월。골절균유합，평균유합시간12．5주（10～21주）。미발생굉골두배사화액신경손상등병발증。근거Neer평분，총분（88．36±7．82）분，기중동통（30．82±3．24）분，공능（23．76±5．71）분，활동도（17．59±5．36）분，해부위치（7．03±2．39）분；결과우18례，량5례，가2례，차1례。결론：응용견봉하경삼각기분리입로운용근단쇄정강판미창치료굉골근단골절，구유창상소、출혈소、고정가고、골절유합솔고、공능회복호등우점。
Objective:To investigate the effects of locking plate fixation through lateral deltoid approach for proximal humeral fracture combined with micro invasive percutaneous plating (MIPPO) technique. Methods:From April 2009 to March 2012,26 patients with proximal humeral fractures were treated with proximal humeral locking system plate fixation through lateral deltoid approach,including 17 males and 9 females with an average age of 58 years old ranging from 28 to 76 years old. The time from injury to operation was 3 to 10 days (averaged 5.6 days). According to Neer typing for the proximal humeral fractures,7 cases had 2 parts of fracture,15 had 3 parts of fracture,and 4 had 4 parts of fracture. The Neer score for shoulder function was evaluated. Results:All patients were followed up,and the duration ranged from 10 to 21 months (aver-aged 13.6 months). All patients were achieved bony union,the average healing time was 12.5 weeks (ranged from 10 to 21 weeks). No humeral head necrosis and axillary nerve injury occurred. According to Neer scoring system ,the total score was 88.36±7.82,pain 30.82±3.24,function 23.76±5.71,activity 17.59±5.36,anatomical position 7.03±2.39;the result was excel-lent in 18 cases,good in 5 cases,fair in 2 cases,poor in 1 case. Conclusion:Lateral deltoid approach combined with locking plate fixation for treatment of proximal humeral fracture has advantages of small invasion ,less blood lossing,short operative time,stable fixation,high rate of fracture healing,and satisfactory functional recovery.