CAJ | 학술논문

目的应用数字骨科技术探讨肱骨近端锁定钢板(PHILOS)治疗肱骨近端骨折失败的因素.方法回顾分析我院47例肱骨近端骨折患者,患者术前均做三维CT重建,利用计算机模拟软件分析肱骨内侧壁是否完整,肱骨头松质骨密度及分布,模拟安置的肱骨近端锁定加压钢板(LCP)螺钉同肱骨头骨骨质的把持关系.根据以上指标分为骨质正常组(A组)和骨质疏松组(B组),记录两组患者的骨折复位维持情况,对内固定物失效情况进行比较.结果骨质异常组术后骨折复位维持情况及内固定失效情况高于骨质正常组.结论对于骨折疏松合并内侧壁缺失的患者,肱骨近端锁定钢板同样存在内固定失效的风险.内侧植骨可以减少失效的发生.
목적 응용수자골과기술탐토굉골근단쇄정강판(PHILOS)치료굉골근단골절실패적인소.방법 회고분석아원47례굉골근단골절환자,환자술전균주삼유CT중건,이용계산궤모의연건분석굉골내측벽시부완정,굉골두송질골밀도급분포,모의안치적굉골근단쇄정가압강판(LCP)라정동굉골두골골질적파지관계.근거이상지표분위골질정상조(A조)화골질소송조(B조),기록량조환자적골절복위유지정황,대내고정물실효정황진행비교.결과 골질이상조술후골절복위유지정황급내고정실효정황고우골질정상조.결론 대우골절소송합병내측벽결실적환자,굉골근단쇄정강판동양존재내고정실효적풍험.내측식골가이감소실효적발생.
Objective To explore the reasons of failure in the treatment of proximal humerus fractures by PHILOS using computer simulation.Methods A retrospective review of 47 cases of proximal humerus fractures was conducted.Preoperative spiral CT scanning was obtained in all the patients for 3D reconstruction to determine whether the medial cortical support was intact.Cancelous bone density of the humeral head and its distribution were analyzed.Simulation of fracture reduction and internal fixation with locking compression plate were carried out in MIMICS.The patients were divided into 2 groups:group A (normal) and group B (with osteoporosis and lack of medial cortical support).Maintenance of reduction and failure of the internal fixation were compared between the two groups.Results The failure rate of PHILOS in group B was significantly higher than that of group A.Conclusion There are potential risks in the treatment of proximal humerus fractures by PHILOS in cases with osteoporosis and lack of medial cortical support.Medial side bone graft can decrease failure rate.