ロッキングプレートは上腕骨近位端骨折に対する骨接合術の適応範囲を拡大させうるか？

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Background: The purpose of this study was to evaluate the clinical results of osteosynthesis with locking plates (LP) for 3 or 4-part proximal humeral fractures (PHFs). Methods: We studied 22 PHFs of 22 patients who underwent osteosynthesis with LP from 2001 to 2010. From 2001 to 2006, we used Locking Humerus Spoon Plate (LHSP) and from 2006 to 2010, we used Proximal Humeral Internal Locking System (PHILOS). There were 4 male and 18 female patients. According to Neer's classification, there was one 4-part fracture-dislocation (group (1)), four 4-part fractures (group (2)), six 3-part fracture-dislocations in patients over 50 years old (group (3)), and fifteen 3-part fractures in patients over 50 years old (group (4)). The average age at operation was 69.3 ((1) 82 (2) 52.7 (3) 77.0 (4) 69.2) years old. The mean follow-up period was 17.0 ((1) 10 (2) 25.3 (3) 15.6 (4) 16.2) months. Results: The average JOA score was 81.1 ((1) 90 (2) 73.0 (3) 72.6 (4) 85.9) points. The mean active elevation was 120.5 ((1) 80 (2) 123.3 (3) 103.0 (4) 129.6) degrees. There was one deep infection in group (2) and one avascular necrosis (AVN) in group (3). Discussion: Neer reported the incidence of AVN was 21% in 3 and 4-part PHFs. Our study showed the decreased incidence of AVN (4.5%) in 3 and 4-part PHFs treated with LP. The functional outcome of ORIF for PHFs has been getting better and the incidence of AVN has been decreasing since the appearance of LP. So, it is possible that locking plates increase the indication of osteosynthesis for proximal humeral fractures.

ロッキングプレートは上腕骨近位端骨折に対する骨接合術の適応範囲を拡大させうるか？

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