CAJ | 학술논문

背景:以往对肱骨近端4部分骨折患者行切开复位内固定时常使用非锁定的解剖钢板,难以获得稳定的固定,固定后并发骨折再移位及肱骨头坏死的概率相对较高.目的:观察肱骨近端锁定钢板治疗肱骨近端4部分骨折的临床疗效.方法:肱骨近端4部分骨折的患者72例,其中无肱骨头脱位40例,肱骨头脱位32例,均给予切开复位、肱骨近端锁定钢板锁定系统固定,固定后3周内给予肩关节制动,之后逐渐开始功能锻炼.定期随访,通过Neer评分评价肩关节的功能.结果与结论:末次随访3,6,9,12,18,≥24个月的患者数分别为6,13,31,9,8,5例.末次随访≥9个月的53例,骨折愈合率达98%(52/53),Neer评分中级以上达85%(45/53),肱骨头坏死率6%(3/53).X射线检查显示3例均为固定前肱骨头脱位患者,肩峰撞击综合症发生率9%(5/53),无内固定松动、螺钉断裂.固定前肱骨头脱位固定后肱骨头坏死和 Neer 评分与固定前无肱骨头脱位比较差异无显著性意义.说明肱骨近端锁定钢板治疗肱骨近端4部分骨折利于骨折块复位,固定牢靠,固定后肩关节功能恢复良好,并发症较少.
배경:이왕대굉골근단4부분골절환자행절개복위내고정시상사용비쇄정적해부강판,난이획득은정적고정,고정후병발골절재이위급굉골두배사적개솔상대교고.목적:관찰굉골근단쇄정강판치료굉골근단4부분골절적림상료효.방법:굉골근단4부분골절적환자72례,기중무굉골두탈위40례,굉골두탈위32례,균급여절개복위、굉골근단쇄정강판쇄정계통고정,고정후3주내급여견관절제동,지후축점개시공능단련.정기수방,통과Neer평분평개견관절적공능.결과여결론:말차수방3,6,9,12,18,≥24개월적환자수분별위6,13,31,9,8,5례.말차수방≥9개월적53례,골절유합솔체98%(52/53),Neer평분중급이상체85%(45/53),굉골두배사솔6%(3/53).X사선검사현시3례균위고정전굉골두탈위환자,견봉당격종합증발생솔9%(5/53),무내고정송동、라정단렬.고정전굉골두탈위고정후굉골두배사화 Neer 평분여고정전무굉골두탈위비교차이무현저성의의.설명굉골근단쇄정강판치료굉골근단4부분골절리우골절괴복위,고정뢰고,고정후견관절공능회복량호,병발증교소.
BACKGROUND:Non-locking anatomical plate is commonly used for open reduction and internal fixation for the treatment of four-part proximal humeral fracture, but it has the high probability of fracture re-displacement and humeral head necrosis after fixation. OBJECTIVE:To observe the clinical results of proximal humeral locking plates fixation for the treatment of four-part proximal humeral fracture. METHODS:Seventy-two patients with four-part proximal humeral fracture were included, 32 patients with dislocation of the humeral head and the other 40 patients without, and al patients were treated with open reduction and fixation with proximal humeral locking plates. Shoulder’s movement was restricted within 3 weeks after surgery, and then gradual y began to perform the functional exercise. Al patients were fol owed-up regularly and Neer scores were recorded to evaluate the function of shoulder after union of fractures. RESULTS AND CONCLUSION:At the time of final fol owed-up, 6 patients were fol owed-up for 3 months, 13 patients were fol owed-up for 6 months, 31 patients for 9 months, 9 patients for 12 months, 8 patients for 18 months and 5 patients for at least 24 months. Fifty-three patients were fol owed-up for at least 9 months, the rate of fracture union was 98%(52/53), Neer scores with intermediate and above the intermediate level was 85%(45/53), humeral head osteonecrosis was 6%(3/53), and al the 3 patients were preoperative humeral head dislocation, subacromial impingement syndrome was 9%(5/53), and no screw loosing or fracture occured. There were no significant differences of Neer score and humeral head necrosis between patients with and without preoperative humeral head dislocation. The application of proximal humeral locking plate for the treatment of four-part proximal humeral fracture is helpful to the reduction of four-part fractured fragments and its fixation is stable. The recovery of postoperative shoulder functions is satisfactory and low rate of complications can be obtained fol owing locking plate treatment of four-part fracture.