骨粗鬆症を伴う上腕骨近位端骨折に対する順行性直線型髄内釘法

Antegrade Straight Interlocking Nail for Proximal Humeral Fractures Associated with Osteoporosis

　抄録：骨粗鬆症を伴う上腕骨近位端骨折に対して直線型髄内釘（ターゴンPH^®）を用い，良好な機能回復を得たので治療成績と同髄内釘の特徴や手技を考察する．手術は14例（平均69歳）に行い，術後6カ月における平均可動域は屈曲163°，外旋72°，内旋Th12，JOAスコアは平均97点であった．ターゴンPH^®は直線型で近位骨片に横止めスクリューを多方向に挿入できるため，転位の回避や強固な固定により早期可動域訓練が可能であった．骨折部の十分な整復と適切な挿入位置の決定，腱板の確実な保護および修復が重要である．

　We performed internal fixation with an antegrade straight interlocking nail (Targon PH^®) to treat proximal humeral fractures associated with osteoporosis, and obtained good outcomes as a result of rigid stabilization. The purpose of our study was to evaluate treatment outcome, and assess the features of the implant and the surgical technique involved. Fourteen patients were treated with the implant, and six months later the average range of motion of the shoulder joint was 163 degrees of flexion, 72 degrees of external rotation, and internal rotation to Th12. The mean JOA score was 97 points. The Targon PH^® nail is straight, and has four interlocking screws, each at a different level of the humeral head. The rigid stabilization allows early physiotherapy even in osteoporotic patients. We believe that it is important to reduce the displacement precisely, to decide on the most suitable entry point, and to repair the rotator cuff reliably.