CAJ | 학술논문

目的：比较肱骨近端锁定加压钢板与解剖钢板治疗老年肱骨外科颈骨折的临床疗效。方法将50例老年肱骨外科颈骨折患者按治疗方法分为两组,使用肱骨近端锁定加压钢板治疗(锁定钢板组)25例,使用肱骨近端解剖钢板治疗(解剖钢板组)25例,比较两组手术时间、术中出血量、术后住院天数、术后骨折愈合时间、术后关节活动度、术后3个月Neer肩关节功能评分及术后并发症的情况。结果50例均获得随访,时间12~18(13．5±4．1)个月。手术时间(min)：锁定钢板组为55．3±23．7,解剖钢板组为73．7±30．3,P<0．05。术中出血量(ml)：锁定钢板组为189．5±34．5,解剖钢板组为273．2±39．8,P<0．05。术后住院时间(d)：锁定钢板组为8．3±3．1,解剖钢板组为10．5±4．2,P <0．05。术后骨折骨性愈合时间(d)：锁定钢板组为97．2±23．8,解剖钢板组为119．5±34．5,P<0．05。肩关节活动度：锁定钢板组优于解剖钢板组(P<0．05)。术后3个月采用Neer肩关节功能评分进行比较：锁定钢板组优良率为23/25,解剖钢板组优良率为21/25,两组比较差异无统计学意义(P>0．05)。术后并发症：锁定钢板组无肱骨头缺血坏死,无内固定松动及断裂；解剖钢板组出现螺钉松动退钉1例,钢板断裂1例。结论肱骨近端锁定加压钢板设计合理,操作简便,同时具有固定和加压作用,固定牢固,可早期功能锻炼,肩关节功能恢复良好,术后骨折愈合快,治疗老年肱骨外科颈骨折疗效更好。
목적：비교굉골근단쇄정가압강판여해부강판치료노년굉골외과경골절적림상료효。방법장50례노년굉골외과경골절환자안치료방법분위량조,사용굉골근단쇄정가압강판치료(쇄정강판조)25례,사용굉골근단해부강판치료(해부강판조)25례,비교량조수술시간、술중출혈량、술후주원천수、술후골절유합시간、술후관절활동도、술후3개월Neer견관절공능평분급술후병발증적정황。결과50례균획득수방,시간12~18(13．5±4．1)개월。수술시간(min)：쇄정강판조위55．3±23．7,해부강판조위73．7±30．3,P<0．05。술중출혈량(ml)：쇄정강판조위189．5±34．5,해부강판조위273．2±39．8,P<0．05。술후주원시간(d)：쇄정강판조위8．3±3．1,해부강판조위10．5±4．2,P <0．05。술후골절골성유합시간(d)：쇄정강판조위97．2±23．8,해부강판조위119．5±34．5,P<0．05。견관절활동도：쇄정강판조우우해부강판조(P<0．05)。술후3개월채용Neer견관절공능평분진행비교：쇄정강판조우량솔위23/25,해부강판조우량솔위21/25,량조비교차이무통계학의의(P>0．05)。술후병발증：쇄정강판조무굉골두결혈배사,무내고정송동급단렬；해부강판조출현라정송동퇴정1례,강판단렬1례。결론굉골근단쇄정가압강판설계합리,조작간편,동시구유고정화가압작용,고정뢰고,가조기공능단련,견관절공능회복량호,술후골절유합쾌,치료노년굉골외과경골절료효경호。
Objective To compare clinical effect of locking compression plate ( LCP) of proximal humerus and ana-tomical plate ( AP) of proximal humerus in elderly osteoporotic population. Methods 50 elderly osteoporotic pa-tients with proximal humeral fracture were treated with LCP (25cases) and AP (25 cases) respectively. The opera-tion time, intraoperation bleeding, postoperative time of hospitalization, postoperative fracture healing time, postoper-ative rang of motion ( ROM) of shoulder, postoperative complication and Neer scores in 3 months after surgery were observed. Result All patients were followed up for 12~18(13. 5 ± 4. 1)months. The operation time in LCP group was (55. 3 ± 23. 7) min and AP group was (73. 7 ± 30. 3) min,P<0. 05. The blood loss in LCP group was (189. 5 ± 34. 5) ml and AP group was (273. 2 ± 39. 8) ml, P<0. 05. The time of hospitalization in LCP group was (8. 3 ± 3. 1) d and AP group was (10. 5 ± 4. 2) d,P<0. 05. The postoperative fracture healing time in LCP group was (97. 2 ± 23. 8) d and AP group was (119. 5 ± 34. 5) d,P<0. 05. There was statistically differences between two groups of ROM of shoulder ( P <0. 05 ) . The shoulder function was examined and evaluated with Neer score in 3 months postoperative, the excellent and good rate in LCP group was 23/25 and AP group was 21/25, which was no significant differences(P>0. 05). No instrument failure was found in LCP group and 2 cases developed instrument failure in AP group. No complication such as avascular necrosis of the humeral head or internal fixation failure were found in LCP group,and there was 1 case developed screw loose and 1 case developed plate fracture in AP group. Conclusions Compared with the AP, LCP in treating proximal humeral fractures have advantages of reasonable de-sign, simple operation, strong fixation, faster fracture healing, and also can let shoulder function exercise early. It is an more effective method to treat proximal humeral fracture for the elderly patients.