Search

This study aimed to compare the postoperative shoulder range of motion (ROM) and complication rates in patients with proximal humeral fractures that were treated with antegrade intramedullary nails or locking plates. Between 2008 and 2016, the shoulders of 108 patients with proximal humeral fractures underwent internal fixation using antegrade intramedullary nails (N group) or locking plates (P group). Of these, 42, 48, and 18 shoulders exhibited two-, three-, and four-part fractures, respectively. For patients with three- or four-part fractures, the mean age in the P group was significantly less compared with that in the N group. The mean operation time, blood loss, and postoperative follow-up period did not significantly differ between the N and P groups. The external rotation of two-part fractures in the N group was significantly better than in the P group. The external rotation of threeand four-part fractures in patients aged 65－74 years was significantly better in the N group than in the P group. For two-part fractures in the N group, forward flexion was better in patients aged ＜65 years than in those aged ≧65 years. In three- and four-part fractures, forward flexion was better in patients aged 65－74 years than in those aged ≧75 years in the N group, and it was better in patients aged ＜65 years than in those aged ≧75 years in the P group. In three- and four-part fractures, external rotation was better in patients aged 65－74 years than in those aged ≧75 years in the N group and better in patients aged ＜65 years than in those aged ≧65 years in the P group. Only one patient with a three-part fracture in the P group exhibited nonunion. Avascular necrosis was more likely to occur in patients with three- and four-part fractures. Varus deformity was likely to frequently occur in patients with two-part fractures in the P group. Surgical treatment of proximal humeral fractures provided comparable clinical results in the N and P groups. Except for external rotation, patients with two-part fractures in the N group showed better outcomes than those in the P group. Moreover, elderly patients exhibited poor ROM.

学位論文

大腿骨近位部骨折受傷患者の特徴を明らかにするために，受傷前の日常生活動作（以下ADL）のレベルと認知症の有無について調査を行った．対象は2009年9月から2010年1月までの期間に，沖縄県内の21施設で大腿骨近位部骨折の診断で入院加療を行った310人で，受傷前ADLをBarthel indexで，認知症の有無と程度を改訂版長谷川式認知症スケール（以下HDS-R）で評価した．受傷前ADLはBarthel indexで満点が31％，ある程度の自立が期待できる60点以上が64％で，年齢とBarthel indexには相関係数－0.369の負の相関が認められた．HDS-Rで14点以下を認知症有りと判断すると，52％に認知症が認められ，4点以下の高度認知症は27％であった．HDS-Rと年齢には相関係数－0.493の負の相関が認められた．Barthel indexとHDS-Rには相関係数0.681の正の相関関係が認められた．認知症の程度が高度になるにつれBarthel indexの点数が60点未満の者を多く含むようになり，逆に認知症を認めない者ではその多くがBarthel indexの点数は60点以上であった．

This study aimed to compare the postoperative shoulder range of motion (ROM) and complication rates in patients with proximal humeral fractures that were treated with antegrade intramedullary nails or locking plates. Between 2008 and 2016, the shoulders of 108 patients with proximal humeral fractures underwent internal fixation using antegrade intramedullary nails (N group) or locking plates (P group). Of these, 42, 48, and 18 shoulders exhibited two-, three-, and four-part fractures, respectively. For patients with three- or four-part fractures, the mean age in the P group was significantly less compared with that in the N group. The mean operation time, blood loss, and postoperative follow-up period did not significantly differ between the N and P groups. The external rotation of two-part fractures in the N group was significantly better than in the P group. The external rotation of threeand four-part fractures in patients aged 65－74 years was significantly better in the N group than in the P group. For two-part fractures in the N group, forward flexion was better in patients aged ＜65 years than in those aged ≧65 years. In three- and four-part fractures, forward flexion was better in patients aged 65－74 years than in those aged ≧75 years in the N group, and it was better in patients aged ＜65 years than in those aged ≧75 years in the P group. In three- and four-part fractures, external rotation was better in patients aged 65－74 years than in those aged ≧75 years in the N group and better in patients aged ＜65 years than in those aged ≧65 years in the P group. Only one patient with a three-part fracture in the P group exhibited nonunion. Avascular necrosis was more likely to occur in patients with three- and four-part fractures. Varus deformity was likely to frequently occur in patients with two-part fractures in the P group. Surgical treatment of proximal humeral fractures provided comparable clinical results in the N and P groups. Except for external rotation, patients with two-part fractures in the N group showed better outcomes than those in the P group. Moreover, elderly patients exhibited poor ROM., 論文