高齢者の上腕骨近位端粉砕骨折に対する骨接合 vs 人工骨頭置換術

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Background: The aim of this study was to compare the clinical outcomes of open reduction internal fixation by intramedullary nail (ORIF group) and humeral head replacement (HHR group). Methods: Twenty-six elderly patients who were over 65 years-old were followed for more than 6months after 1998. In ORIF group, there were 17 shoulders (2 men, 15 women) and the average follow-up period was 20.5 months (6-54 months). In HHR group, there were 9 shoulders (1 man, 8 women) and the average follow-up period was 29.7 months (6-60 months). Five shoulders which had necrosis of the humeral head were excluded. All patients were evaluated with the Modified-Neer classification, range of motion of flexion and external rotation. Results: In Modified-Neer classification, two shoulders were classified as excellent, 13 shoulders as satisfactory and 2 shoulders as unsatisfactory in ORIF group, and no shoulders were classified as excellent, 2 shoulders as satisfactory and 7 shoulders as unsatisfactory in HHR group. Postoperative flexion angle was 115.4 degrees in ORIF group and 87.9 degrees in HHR group. Postoperative external rotation angle was 30.5 degrees in ORIF group and 18.6 degrees in HHR group. Discussion: ORIF group has a better clinical result than HHR group. ORIR was desirable if possible, however, when there was high risk of humeral head necrosis in elderly patiants, HHR must be chosen. After this, surgical technique and postoperative protocol of humeral head replacement need to be improved.

高齢者の上腕骨近位端粉砕骨折に対する骨接合 vs 人工骨頭置換術

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