CAJ | 학술논문

目的探讨双钢板治疗涉及内侧干骺端稳定性无法通过常规手段予以维持的陈旧性肱骨近端骨折的疗效. 方法回顾性分析2005年1月至2012年6月采用切开复位双钢板内固定治疗且获1年以上随访的10例陈旧性干骺端不稳定型肱骨近端骨折患者资料,男6例,女4例;年龄26～51岁,平均38.8岁.主力侧(均为右侧)7例.骨折Neer分型:二部分内翻型外科颈骨折7例,三部分大结节骨折1例,四部分骨折2例(非外展嵌插型骨折).末次随访时记录肩关节活动范围、功能评分、疼痛视觉模拟评分(VAS)及术后并发症发生情况,并与术前进行比较. 结果 10例患者获平均16.9个月(12 ～50个月)随访.末次随访时肩关节平均活动范围:前屈上举(FE) 144.0°±30.6°,体侧外旋(ER) 34.5°±27.2°,内旋(IR)从术前的L2恢复至T10水平.Constant-Murley评分平均为(84.4±12.9)分,美国肩肘关节(ASES)评分平均为(79.5±20.2)分,美国加州大学洛杉矶分校(UCLA)评分平均为(28.7±5.1)分,简单肩关节(SST)问卷调查评分平均为(9.6±1.7)分,VAS评分平均为(1.7±2.5)分.Constant满意程度评分:优8例,良2例.10例患者的FE、ER、Constant-Murley评分、ASES评分、UCLA评分、SST问卷调查评分和VAS评分术前与末次随访时比较差异均有统计学意义(P＜0.05).2例患者出现肱骨头缺血性坏死,1例患者出现骨折迟延愈合,无其他并发症发生. 结论双钢板治疗涉及内侧干骺端稳定性无法通过常规手段予以维持的陈旧性肱骨近端骨折可较好地恢复肩关节活动范围,疗效满意.
목적 탐토쌍강판치료섭급내측간후단은정성무법통과상규수단여이유지적진구성굉골근단골절적료효. 방법 회고성분석2005년1월지2012년6월채용절개복위쌍강판내고정치료차획1년이상수방적10례진구성간후단불은정형굉골근단골절환자자료,남6례,녀4례;년령26～51세,평균38.8세.주력측(균위우측)7례.골절Neer분형:이부분내번형외과경골절7례,삼부분대결절골절1례,사부분골절2례(비외전감삽형골절).말차수방시기록견관절활동범위、공능평분、동통시각모의평분(VAS)급술후병발증발생정황,병여술전진행비교. 결과 10례환자획평균16.9개월(12 ～50개월)수방.말차수방시견관절평균활동범위:전굴상거(FE) 144.0°±30.6°,체측외선(ER) 34.5°±27.2°,내선(IR)종술전적L2회복지T10수평.Constant-Murley평분평균위(84.4±12.9)분,미국견주관절(ASES)평분평균위(79.5±20.2)분,미국가주대학락삼기분교(UCLA)평분평균위(28.7±5.1)분,간단견관절(SST)문권조사평분평균위(9.6±1.7)분,VAS평분평균위(1.7±2.5)분.Constant만의정도평분:우8례,량2례.10례환자적FE、ER、Constant-Murley평분、ASES평분、UCLA평분、SST문권조사평분화VAS평분술전여말차수방시비교차이균유통계학의의(P＜0.05).2례환자출현굉골두결혈성배사,1례환자출현골절지연유합,무기타병발증발생. 결론 쌍강판치료섭급내측간후단은정성무법통과상규수단여이유지적진구성굉골근단골절가교호지회복견관절활동범위,료효만의.
Objective To evaluate the results of double plating for obsolete proximal humeral fractures whose instability of medial metaphysis cannot be maintained conventionally.Methods From January 2005 to June 2012,we treated 10 patients with the obsolete proximal humeral fracture mentioned above with double plating.They were 6 men and 4 women,aged from 26 to 51 years (average,38.8 years).The fractures involved 8 principal sides (all right sides).By the Neer classification,7 cases were two-part varus fractures of surgical neck,one three-part fractures of greater tubercle,and 2 four-part fractures (non-abduction compact ones).The range of motion of the shoulder,visual analogue scale (VAS),American Shoulder and Elbow Score (ASES),Constant-Murley score,University of California-Los Angeles (UCLA) score and Simple Shoulder Test (SST) were all recorded for functional evaluation.The results were compared between preoperation and the last follow-up.Results The 10 patients were followed up for an average of 16.9 months (from 12 to 50 months).At the last follow-up,the forward flexion was 144.0° ± 30.6°,external rotation 34.5° ±27.2° and internal rotation up to T10 level on average.The Constant-Murley score was 84.4 ± 12.9,ASES 79.5 ± 20.2,UCLA 28.7 ± 5.1,SST 9.6 ± 1.7,and VAS 1.7 ± 2.5.By Constant evaluation,8 patients considered the results as excellent and the other 2 as good.There were significant differences between preoperation and the last follow-up regarding all the above indexes in the 10 obsolete fractures (P ＜ 0.05).Ischemic necrosis of the humeral head occurred in 2 cases and delayed union in one.No other complications were observed.Conclusion Double plating can lead to satisfactory outcomes in treatment of obsolete proximal humeral fractures whose instability of medial metaphysis cannot be maintained conventionally.