CAJ | 학술논문

目的：通过比较肱骨近端锁定板（LPHP）与肱骨近端解剖板（APHP）治疗肱骨近端粉碎性骨折，回顾性评价LPHP的临床效果。方法2007年6月～2011年9月对109例NeerⅢ、Ⅳ型肱骨近端骨折患者资料回顾性分析，根据内固定方式分为两组，LPHP组（59例）和APHP组（50例），对两组患者的手术时间、出血量、骨折愈合时间、骨折愈合率、肱骨头后倾角丢失、肩关节功能优良率及术后并发症等进行比较分析。结果 LPHP组和APHP组平均手术时间分别为90.3±10.6min、100.5±12.6min，术中平均出血量分别为160.8±40.2ml、175.2±45.1ml，两组比较有统计学意义（P＜0.05）。两组患者均获得随访，随访时间14～20个月，平均16个月，104例获得临床骨性愈合，其中LPHP组58例，APHP组46例，两组比较有统计学意义（P＜0.05），LPHP组骨折愈合时间为10～12周，APHP组为12～18.5周，两组比较有统计学意义（P＜0.05）。3例发生肱骨头坏死，其中LPHP组0例， APHP组3例，术后18个月较术后即刻LPHP组肱骨头后倾角丢失约5.6°，APHP组约7.6°，两组比较有统计学意义（P＜0.05）。术后肩关节功能评定根据Neer评分标准，LPHP组优53例、良5例、差1例，APHP优20例、良17例、差13例，两组比较有统计学意义（P＜0.05）。结论采用LPHP治疗肱骨近端粉碎性骨折具有创伤小、操作简单、固定可靠，骨折愈合快，术后恢复快，并发症少。
목적：통과비교굉골근단쇄정판（LPHP）여굉골근단해부판（APHP）치료굉골근단분쇄성골절，회고성평개LPHP적림상효과。방법2007년6월～2011년9월대109례NeerⅢ、Ⅳ형굉골근단골절환자자료회고성분석，근거내고정방식분위량조，LPHP조（59례）화APHP조（50례），대량조환자적수술시간、출혈량、골절유합시간、골절유합솔、굉골두후경각주실、견관절공능우량솔급술후병발증등진행비교분석。결과 LPHP조화APHP조평균수술시간분별위90.3±10.6min、100.5±12.6min，술중평균출혈량분별위160.8±40.2ml、175.2±45.1ml，량조비교유통계학의의（P＜0.05）。량조환자균획득수방，수방시간14～20개월，평균16개월，104례획득림상골성유합，기중LPHP조58례，APHP조46례，량조비교유통계학의의（P＜0.05），LPHP조골절유합시간위10～12주，APHP조위12～18.5주，량조비교유통계학의의（P＜0.05）。3례발생굉골두배사，기중LPHP조0례， APHP조3례，술후18개월교술후즉각LPHP조굉골두후경각주실약5.6°，APHP조약7.6°，량조비교유통계학의의（P＜0.05）。술후견관절공능평정근거Neer평분표준，LPHP조우53례、량5례、차1례，APHP우20례、량17례、차13례，량조비교유통계학의의（P＜0.05）。결론채용LPHP치료굉골근단분쇄성골절구유창상소、조작간단、고정가고，골절유합쾌，술후회복쾌，병발증소。
Objective To retrospectively analyze the results of treatment with Locking Proximal Humeral Plate (LPHP) for Neer III and Ⅳ Proximal Humeral Fracture in comparison with anatomical proximal humeral plate(APHP).Methods In Jun 2007 to sep 2011,109 cases of Neer III and ⅣProximal Humeral Fracture with Locking Proximal Humeral Plate (LPHP) were analyzed retrospectively and the treatment effect was observed.LPHP was used in 59 patients(group A),APHP in 50 patients(group B).The clinical outcomes were compared between the 2 methods,including operation time,the volume of blood loss,fracture healing time,rate of fracture healing,the head of the humerus caster Angle loss,Neer score and complications.Results The operation time averaged 90.3±10.6min,100.5±12.6min in group B.the volume of blood loss averaged 160.8±40.2ml in group A.175.2±45.1ml in group B(P<0.05).All cases were followed-up (mean 16months,range 14~20months). Bone union occurred in 58 cases in group A,in 46 cases in group B(P<0.05).Fracture healing time was 10~12weeks in group A,12~18.5 weeks in group B(P<0.05). Humeral head necrosis occurred in 3 cases in group B.The head of the humerus caster Angle loss was 5.6°in group A,and 7.6°in group postoperative 18 months more postoperative instantly(P<0.05).By neer scoring system,in group A find 53 excellent cases,5 good ones,1 fair one,with 98.3% in excellent and good rate,and in group B find 20 excellent cases,17 good ones,13 fair ones,with 74% in excellent and good rate(P<0.05).Conclusion It is an idealmethod to treatunstable Neer III andⅣ Proximal Humeral Fracture with Locking Proximal Humeral Plate.The procedure is convenient and the fixation is stable,leading to fast fracture healing,good reovery and limited com plications.