Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comparison Study of Different Approach (Deltoid Splitting Approach and Delto-pectoral Interval Approach) for Proximal Humeral Fractures

근위 상완골 골절의 수술적 치료에서 삼각근 분할 도달법과 삼각 대흉간 도달법의 임상적, 방사선학적 추시 결과 비교

  • Kim, Seung-Hee (Department of Orthopedic Surgery Gumi CHA Hospital, CHA Medical University) ;
  • Dan, Jinmyoung (Department of Orthopedic Surgery Gumi CHA Hospital, CHA Medical University) ;
  • Kim, Byoung-Kook (Department of Orthopedic Surgery Gumi CHA Hospital, CHA Medical University) ;
  • Lee, Yun-Seok (Department of Orthopedic Surgery Gumi CHA Hospital, CHA Medical University) ;
  • Kim, Hyoeng-Jung (Bundang CHA Hospital College of Medicine, CHA Medical University) ;
  • Ryu, Keun-Jeong (Bundang CHA Hospital College of Medicine, CHA Medical University) ;
  • Lee, Jin-Hyun (Bundang CHA Hospital College of Medicine, CHA Medical University) ;
  • Kim, Jae-Hwa (Bundang CHA Hospital College of Medicine, CHA Medical University)
  • 김승희 (차의과학대학교 구미차병원 정형외과학교실) ;
  • 단진명 (차의과학대학교 구미차병원 정형외과학교실) ;
  • 김병국 (차의과학대학교 구미차병원 정형외과학교실) ;
  • 이윤석 (차의과학대학교 구미차병원 정형외과학교실) ;
  • 김형종 (분당차병원 정형외과학교실) ;
  • 류근정 (분당차병원 정형외과학교실) ;
  • 이진현 (분당차병원 정형외과학교실) ;
  • 김재화 (분당차병원 정형외과학교실)
  • Received : 2012.11.26
  • Accepted : 2013.06.07
  • Published : 2013.06.30
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Abstract

Purpose: A comparison of the radiographic and the clinical outcomes between two different surgical approaches-Deltoid splitting and Delto-pectoral interval-on the proximal humerus fractures treated by locking compressive plate (LCP), is done. Materials and Methods: Medical records and pre- and postoperative radiographs were reviewed retrospectively for 75 adult patients who underwent surgical fixations with locking compressive plates from May 2005 to December 2011. Patients were divided into two groups according to the surgical methods. Differences in the neck-shaft angle between immediate postoperative period and final follow-up were compared between the two groups. Differences in constant score and Korean shoulder score (KSS) between affected arms and contralateral arms at final follow-up were also compared. Results: The differences in the neck-shaft angle between immediate postoperative period and at final follow-up was 12.04 degrees on average in Deltoid splitting approach and 10.20 degrees in Delto-pectoral interval approach, which was not statistically significant. Differences in constant score/KSS between the affected arm and the contralateral arm were 13.78/22.74 points in deltoid-splitting approach on average and 19.41/31.13 points in Delto-pectoral interval approach, showing that deltoid-splitting approach is significantly superior. Conclusion: Deltoid-splitting approach showed better functional outcomes in the fracture reduction and internal fixation using LCP for the treatment of unstable proximal humerus fractures.

목적: 삼각근 분할 도달법 또는 삼각 대흉간 도달법을 이용하여 잠김 압박 금속판 고정 술을 실시한 근위 상완골 골절의 환자에서 방사선학적, 임상적 결과를 비교 분석하였다. 대상 및 방법: 근위 상완골 불안정성 골절로 잠김 압박 금속판을 이용한 골절의 정복 및 고정술을 실시한 75명의 환자를 대상으로, 평균 38.2주의 추시를 하였으며 각 군에서 수술 후 상완골의 경간각의 변화를 방사선학적 결과로 측정하고, 기능적 결과로 KSS 및 Constant score 차이를 측정하여 비교 분석하였다. 결과: 수술 도달법에 따른 방사선학적 결과에서 상완골 경간각의 차이는 삼각근 분할 도달법에서 평균 12.04도와 삼각 대흉간 도달법에서 평균 10.20도로 통계학적으로 유의한 차이는 없었다. 기능적 결과에서 KSS의 차이와 Constant score의 차이는 삼각근 분할 도달법이 22.74점 및 13.78점으로 삼각 대흉간 도달법의 31.13점과 19.41점보다 우수한 결과를 보였다. 결론: 불안정한 근위 상완골 골절의 치료에서 삼각근 분할 도달법을 통한 골절의 정복과 잠김 압박 금속판을 사용한 고정술이 기능적인 결과의 회복에 더 효과적일 것으로 사료된다.

Keywords

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