CAJ | 학술논문

目的：探讨肱骨近端锁定钢板与肩关节置换术治疗肱骨近端骨折的临床疗效及适应证。方法2006年5月至2011年9月62例肱骨近端骨折患者，其中49例获得随访。男17例，女32例；平均年龄66.5岁（24~83岁），根据Neer分型：二部分骨折23例、三部分骨折16例、四部分骨折10例。49例患者采用肱骨近端锁定钢板治疗36例（内固定组），其中二部分骨折23例、三部分骨折13例。采用肩关节置换治疗13例（关节置换组），其中三部分骨折3例、四部分骨折10例。术后参照Neer肩关节功能评定标准评定疗效。结果内固定组手术时间平均为94min（70~150min），49例患者获得手术后平均18.6个月（12~32个月）随访，无一例出现并发症。按Neer评分系统评价临床结果内固定组优13例、良18例、可4例、差1例，优良率86%；关节置换组优3例、良8例、可1例、差1例，优良率85%。结论年龄<60岁，Neer分型属于二、三部分骨折患者，可以考虑选择肱骨近端锁定钢板治疗，年龄>60岁的四部分骨折可考虑选择肩关节置换术，疗效满意。
목적：탐토굉골근단쇄정강판여견관절치환술치료굉골근단골절적림상료효급괄응증。방법2006년5월지2011년9월62례굉골근단골절환자，기중49례획득수방。남17례，녀32례；평균년령66.5세（24~83세），근거Neer분형：이부분골절23례、삼부분골절16례、사부분골절10례。49례환자채용굉골근단쇄정강판치료36례（내고정조），기중이부분골절23례、삼부분골절13례。채용견관절치환치료13례（관절치환조），기중삼부분골절3례、사부분골절10례。술후삼조Neer견관절공능평정표준평정료효。결과내고정조수술시간평균위94min（70~150min），49례환자획득수술후평균18.6개월（12~32개월）수방，무일례출현병발증。안Neer평분계통평개림상결과내고정조우13례、량18례、가4례、차1례，우량솔86%；관절치환조우3례、량8례、가1례、차1례，우량솔85%。결론년령<60세，Neer분형속우이、삼부분골절환자，가이고필선택굉골근단쇄정강판치료，년령>60세적사부분골절가고필선택견관절치환술，료효만의。
Objective To explore the chinical effects and indications of locking plates and shoulder arthroplasty for proximal humeral fractures. Methods Forty-nine cases of proximal humeral fractures were treated from May 2006 to September 2011.They were 17 men and 32 women,with a mean age of 66.5 years,according to Neer classifation,there were 23 cases of two-part fracture,16 cases of three-part fracture,and 10 cases of four-part fracture. 36 cases(23 in two-part fractures and 13 in three-part fractures) were treated with open reduction and internal fixation(ORIF), 13 cases(three in three-part fractures and 10 in four-part fractures) were treated with shoulder arthroplasty. The clinical efficacy was evaluated according to the Neer's scoring systems. Results In the ORIF group,the average surgical time was94minutes(from 70 to150 minutes) and average blood loss was 260Ml(from 180 to 460mL).The average follow-up was 18.6months(from12 to 40 months).for the 49 cases,No complications were found.The postoperative Neer's score was excellent in 13 cases,good in 18 cases,fair in four cases,bad in one case in the ORIF group.The rate of excellent-to-good was 86%.The postoperative Neer's score was excellent in 3 cases,good in 8 cases,fair in one case,bad in one case in the ORIF group.The rate of excellent-to-good was 85%. Conculsion In treatment of proximal humeral fractures,patients with two-part fracture or three-part fracture and aged<60years can be managed by ORIF. Patients with three-part fractures can be managed and aged>60years can be managed by shoulder arthroplasty.