上腕骨大結節単独骨折の骨折形態が治療成績に及ぼす影響について : 肩関節可動域の改善を中心に  [in Japanese] Difference in the Clinical Results According to Fracture Type of the Major Tubercle of Humerus : Considering Improvement in the ROM of the Shoulder Joint  [in Japanese]

本研究の目的は上腕骨大結節単独骨折の骨折形態が治療成績に影響を与えるか否かについて検討することである。対象は保存的に加療した上腕骨大結節の単独骨折20例とし,これらをX線所見より,裂離骨折群と嵌入骨折群に分類した。受傷原因は裂離骨折群で歩行中の転倒,スキー・スノーボード中の転倒が多く,嵌入骨折群はすべて歩行中の転倒であった。転位は全例軽度に認め、外固定期間及び理学療法の開始時期は両群間に有意差を認めなかった。しかし嵌入骨折群は夜間痛の発生率が高く,受傷後8週目及び12週目の肩関節可動域は上腕下垂位外旋及び結帯動作において著明な制限を有し,拘縮により治療期間が遷延した。嵌入骨折群の発生機序は,転倒の際に肩峰のエッジから受ける剪断力によって生じる縦割れ骨折である。このため受傷時に腱板及び肩峰下滑液包は損傷している可能性が高く,その後の経過で上方支持組織に癒着が生じ,頑固な夜間痛や関節可動域制限を招来したと考えられた。最終的な治療成績は両群間に差を認めなかったが,治療期間は嵌入骨折群で長期間を要することが本研究より示された。

The purpose of this report is to study the correlation between fracture type of the major tubercle of humerus and clinical results. The subjects were 20 patients who had been conservatively treated fractures. They were divided into an avulsion fracture group and impaction fracture group. Causes of avulsion fracture were mainly falls related to walking, skiing and snow boarding. Causes of impaction fracture were falls in all cases. Minimal fracture dislocations were recognized in all cases. Fixation period and start of physical therapy did not differ significantly between the groups. Night rest pain was recognized in 80% of the impaction fracture group. Also, the shoulder joint was contracted at both 8 and 12 weeks after injury. The ROM of shoulder joint was limited with regard to external and internal rotation in this group. This joint contracture required a longer physical therapy period. Impaction fracture is a longitudinal fracture caused by impact force to the acromion at the time of the fall. The rotator cuff and subacromial bursa may be injured and these injured structures develop late tissue adhesions. These adhesions caused the limitation of ROM and the night rest pain. Although the final therapeutic results did not differ between the groups, the present results demonstrated that the impaction fracture group required a longer physical therapy period, compared with the avulsion fracture group.