CAJ | 학술논문

目的探讨闭合复位空心拉力螺钉内固定治疗IdebergⅢ型肩胛盂骨折的早期临床疗效.方法自2005年10月至2012年1月,对9例IdebergⅢ型肩胛盂骨折患者采用闭合复位空心拉力螺钉内固定,回顾性分析手术前后的肩关节评分及影像学资料.男6例,女3例；年龄28～56岁,平均(42.2±8.6)岁；左侧4例,右侧5例.合并锁骨骨折3例,采取锁骨“S”形切口切开复位重建钢板内固定,合并肩锁关节脱位3例采用钩钢板固定,合并肩峰骨折3例采用克氏针张力带钢丝固定.在重建肩关节悬吊结构后行肩胛盂骨折闭合复位空心拉力螺钉内固定治疗.术后给予可调节式肩关节外展支具固定,在医生指导下进行康复练习.术后1、6周、3、6、12个月门诊复查并摄肩关节正位X线片.通过X线及临床检查判断骨折愈合时间,采用美国肩肘协会(American shoulder and elbow society,ASES)肩关节评分评价肩关节功能,记录并发症及相应转归.结果 9例均获得12～46个月,平均(30.8±9.1)个月.骨折均获得愈合,X线骨折愈合时间12～24周,平均(16.8±4.8)周.术后12个月ASES评分为57～95分,平均(82.3±12.8)分,与术前[32～53分,平均(42.3±8.1)分]比较差异有统计学意义.ASES肩关节评分优5例、良2例、可1例、差1例,优良率88.9％.术后未发生皮肤及软组织感染,并发症主要为肩部慢性疼痛2例.ASES肩关节评分为差的l例经口服非甾体类药物及关节内注射玻璃质酸钠后ASES肩关节评分获得改善,术后30个月摄X线片提示创伤性关节炎.无螺钉松动、断裂等内固定失败并发症.结论闭合复位空心拉力螺钉内固定治疗IdebergⅢ型肩胛盂骨折近期可获得满意的疗效.
목적 탐토폐합복위공심랍력라정내고정치료IdebergⅢ형견갑우골절적조기림상료효.방법 자2005년10월지2012년1월,대9례IdebergⅢ형견갑우골절환자채용폐합복위공심랍력라정내고정,회고성분석수술전후적견관절평분급영상학자료.남6례,녀3례；년령28～56세,평균(42.2±8.6)세；좌측4례,우측5례.합병쇄골골절3례,채취쇄골“S”형절구절개복위중건강판내고정,합병견쇄관절탈위3례채용구강판고정,합병견봉골절3례채용극씨침장력대강사고정.재중건견관절현조결구후행견갑우골절폐합복위공심랍력라정내고정치료.술후급여가조절식견관절외전지구고정,재의생지도하진행강복연습.술후1、6주、3、6、12개월문진복사병섭견관절정위X선편.통과X선급림상검사판단골절유합시간,채용미국견주협회(American shoulder and elbow society,ASES)견관절평분평개견관절공능,기록병발증급상응전귀.결과 9례균획득12～46개월,평균(30.8±9.1)개월.골절균획득유합,X선골절유합시간12～24주,평균(16.8±4.8)주.술후12개월ASES평분위57～95분,평균(82.3±12.8)분,여술전[32～53분,평균(42.3±8.1)분]비교차이유통계학의의.ASES견관절평분우5례、량2례、가1례、차1례,우량솔88.9％.술후미발생피부급연조직감염,병발증주요위견부만성동통2례.ASES견관절평분위차적l례경구복비치체류약물급관절내주사파리질산납후ASES견관절평분획득개선,술후30개월섭X선편제시창상성관절염.무라정송동、단렬등내고정실패병발증.결론 폐합복위공심랍력라정내고정치료IdebergⅢ형견갑우골절근기가획득만의적료효.
Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed.Conclusion Closed reduction and cannulated screws internal fixation of Ideberg Ⅲ type glenoid fractures recently obtained satisfactory results.