高齢者上腕骨頭の領域別骨密度と骨強度の検討

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Treatment of proximal humeral fractures is very challenging in elderly patients with osteoporosis. To get the good stability at the fracture site we need to know the suitable region to insert screws. We examined cadavers` proximal humeral heads to know the difference of bone mineral density (BMD) and bone strength in this study.(Method) 6 cadavers humerus (mean age 84,1) were used. BMD was measured by DEXA. On the coronal plane the osteotomy was performed on the middle of the humeral head and sliced 1 cm thickness. Then we made two lines. One was the humeral shaft line which passed the greater tuberosity(GT), the other was the surgical neck line. We decided region A; medial surgical neck, B; 30° above A , C; 60°above A, D; GT, E: lateral surgical neck, F; 1 cm medial side from B, G; 1cm medial side from C. The maximum load value was measured at the each region of each segment by the universal material examination machine ( Instron 5882 ). Mean BMD at each region were A; 0.12, B; 0.24, C; 0.14, D; 0.12, E; 0.7, F; 0.15, G; 0.1. Mean maximum load value at each region were A; 140N, B; 348N, C; 253N, D; 147N, E; 99N, F; 161N, G; 45N. Concerning BMD value B was significantly higher than all regions except C. And C was significantly higher than ADEG. Concerning the mean maximum load value B was significantly higher than A,C,D,E,F and G( p < 0.05 ). C was significantly higher than A,D,E,F and G( p < 0.05 ). D, D and F were significantly higher than G( p < 0.05 ). Our result shows that BMD and the bone strength is different in the proximal humeral head. During the operation we should consider the above result and insert screws 30 degree upward from the surgical neck to the subchondral bone near the top of the proximal humeral head to get good stability at the fracture site.

高齢者上腕骨頭の領域別骨密度と骨強度の検討

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