CAJ | 학술논문

目的：探讨星型钢板小切口治疗肱骨大结节骨折的临床疗效。方法2010年5月～2012年12月我院采用星型钢板微创治疗17例肱骨大结节骨折，均为闭合性损伤且肱骨大结节骨折块均向上移位超过5 mm和（或）向后移位超过10 mm。臂丛神经阻滞麻醉（15例）或全麻（2例）下，取仰卧位，经肩部正中切口约3．5 cm，依次切开皮肤及各层组织，直至显露骨折块，撬拨复位，选用星型钢板固定撕脱的大结节骨块，若撕脱的骨块偏大加用1～2枚空心螺钉协助固定。术中被动活动肩关节，见骨折固定牢固，无松动。术后患肢悬吊胸前固定，术后1周开始被动进行肩关节的功能锻炼，2周拆线，3周后进行肩关节主动功能锻炼。结果17例均顺利完成手术，手术时间平均35 min（30～40 min），术中出血量平均42 ml（35～48 ml），住院时间平均7 d（6～9 d）。均无切口感染、骨不愈合、神经损伤、内固定松动等并发症。17例随访12～24个月，平均18个月，切口均一期愈合。17例术后4～6个月X线显示骨折愈合，均达到影响学解剖复位标准。末次随访肩关节Constant评分平均96．2分（94．5～97．8分）。结论星型钢板治疗单纯肱骨大结节骨折具有骨折不易移位，内固定牢靠，肩关节早期功能锻炼等优点，疗效满意。
목적：탐토성형강판소절구치료굉골대결절골절적림상료효。방법2010년5월～2012년12월아원채용성형강판미창치료17례굉골대결절골절，균위폐합성손상차굉골대결절골절괴균향상이위초과5 mm화（혹）향후이위초과10 mm。비총신경조체마취（15례）혹전마（2례）하，취앙와위，경견부정중절구약3．5 cm，의차절개피부급각층조직，직지현로골절괴，효발복위，선용성형강판고정시탈적대결절골괴，약시탈적골괴편대가용1～2매공심라정협조고정。술중피동활동견관절，견골절고정뢰고，무송동。술후환지현조흉전고정，술후1주개시피동진행견관절적공능단련，2주탁선，3주후진행견관절주동공능단련。결과17례균순리완성수술，수술시간평균35 min（30～40 min），술중출혈량평균42 ml（35～48 ml），주원시간평균7 d（6～9 d）。균무절구감염、골불유합、신경손상、내고정송동등병발증。17례수방12～24개월，평균18개월，절구균일기유합。17례술후4～6개월X선현시골절유합，균체도영향학해부복위표준。말차수방견관절Constant평분평균96．2분（94．5～97．8분）。결론성형강판치료단순굉골대결절골절구유골절불역이위，내고정뢰고，견관절조기공능단련등우점，료효만의。
Objective To observe clinical effects of application of small incision and star plate in the treatment of greater tuberosity fractures . Methods A retrospective analysis of 17 cases of humeral greater tuberosity fracture treated by star plate fixation from May 2010 to December 2012 was carried out .All the fractures were caused by blunt trauma .The humeral greater tuberosity fracture fragments were displaced upwards over 5 mm and (or) backwards over 10 mm.Under brachial plexus anesthesia (15 patients) or general anesthesia (2 patients), the patients were operated in a supine position .Through a shoulder incision approximately 3.5 cm in length, layers of tissues were cut open until the exposure of the fracture blocks .After poking reduction, a star plate fixation of the greater tuberosity avulsion bone was employed .If the bone avulsion was relatively large, 1 or 2 cannulated screws were utilized for fixation assistance .During the surgery, the shoulder was passively mobilized to confirm the fixation without loosening .Postoperatively, the limb was suspension fixed before the chest .Passive functional exercise was given at 1 postoperative week .The stitches were removed 2 weeks after surgery .Active functional exercise of the shoulder was conducted 3 weeks after surgery . Results The operation was accomplished in all the 17 cases.The mean operation time was 35 min (30-40 min), the mean intraoperative blood loss was 42 ml (35-48 ml), and the mean length of hospital stay was 7 d (6 -9 d).No incisional infection, nonunion, nerve injury, or internal fixation loosening were detected .All the 17 patients were followed up for 12-24 months (mean, 18 months).All of the incisions got healing by first intention .The X-ray showed that fractures healed 4-6 months after operation .According to the last follow-up date postoperative constant scores, an average of 96.2 points (94.5-97.8 points) was obtained. Conclusion Use of star plate for the treatment of simple humeral greater tuberoses fracture has advantages of seldom fracture displacement, internal rigid fixation, and early functional exercise of shoulder joint .