上腕骨近位端骨折に対する髄内釘 • 鋼線締結法の治療経験

概要

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The purpose of this study was to evaluate the clinical results of our surgical treatment for proximal humeral fractures. During the period between April 2003 and March 2007, we performed intramedullary fixation with tension band wiring as the surgical treatment of proximal humeral fractures for the elderly. We followed up 31 cases (3 males and 28 females) for more than 6 months after surgery in the population older than 70 years old. The average age of the patients was 78.8 (range, 70 to 90 years old). 21 cases were classified into 2-part fracture, 5 into 3-part fracture, 4 into 4-part fracture, and the last 1 was unclassifiable by Neers classification. Clinical results were evaluated retrospectively at the time of 6 months after surgery. We observed bone union in all the cases. The mean postoperative JOA score was 80.5 (range, 60 to 96). No cases had an evidence of avascular necrosis of the humeral head. However, we observed loosening of the fixation in 2 cases and protrusion of the intramedullary Kirschner wires followed by subacromial impingement in 6 cases. Satisfactory outcomes were achieved with our surgical procedure and we regarded this method as useful for proximal humeral fractures for the elderly. However some contrivances are needed to avoid complications after surgery in particular cases.
日本肩関節学会の論文