臨床整形外科50巻1号

2015年01月発行

Lecture

上腕骨近位端骨折の治療

著者： 玉井和哉¹ 矢野雄一郎¹

所属機関： ¹獨協医科大学医学部整形外科学

ページ範囲：P.21 - P.27

はじめに

　上腕骨近位端骨折は全骨折の4〜5％を占める⁴⁾．女性では男性の2倍以上発生し，80〜89歳女性で最も発生頻度が高いとされている⁴⁾．70歳女性がその後10年間に本骨折を起こす絶対リスクは5〜7％であること²⁾，上腕骨近位端骨折を生じると，その後1年間，大腿骨頚部骨折のリスクが5倍になること⁶⁾なども知られている．また上腕骨近位端骨折の87％は立った高さからの転倒，すなわちlow energy traumaによって生じる⁴⁾．しかし，外出の多い生活をしている人は骨折リスクが低い¹⁵⁾．このように上腕骨近位部骨折の多くは，活動性の高くない高齢者の脆弱な骨に発生する．脆弱な骨でも適用可能な方法を選択することが治療のポイントと言える．

参考文献

1) Agudelo J, Schurmann M, Stahel P, et al:Analysis of efficacy and failure in proximal humeral fractures treated with locking plates. J Orthop Trauma 21:676-681, 2007

2) Ahmed LA, Schirmer H, Bjørnerem A, et al:The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24:441-448, 2009

3) Anakwenze OA, Zoller S, Ahmad CS, et al:Reverse shoulder arthroplasty for acute proximal humerus fractures:a systematic review. J Shoulder Elbow Surg 23:e73-e80, 2014

4) AO Foundation. Evidence summary. Epidemiology of proximal humeral fractures. https://www.aofoundation.org/

5) Clement ND, Duckworth AD, McQueen MM, et al:The outcome of proximal humeral fractures in the elderly. Predictors of mortality and function. Bone Joint J 96-B:970-977, 2014

6) Clinton J, Franta A, Polissar NL, et al:Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am 91:503-511, 2009

7) Court-Brown CM, McQueen MM:Impacted varus (A2.2) proximal humeral fracture. Prediction of outcome and results of nonoperative treatment in 99 patients. Acta Orthop Scand 75:736-740, 2002

8) Cuny C, Scarlat MM, Irrazi M, et al:The telegraph nail for proximal humeral fractures:A prospective four-year study. J Shoulder Elbow Surg 17:539-545, 2008

9) DeFranco MJ, Brems JJ, Williams GR Jr, et al:Evaluation and management of valgus impacted four-part proximal humerus fractures. Clin Orthop Relat Res 442:109-114, 2006

10) Demirhan M, Kilicoglu O, Altinel L, et al:Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:181-188, 2007

11) Gaebler C, McQueen MM, Court-Brown CM:Minimally displaced proximal humeral fractures. Epidemiology and outcome in 507 cases. Acta Orthop Scand 74:580-585, 2003

12) Gardner MJ, Weil Y, Barker JU, et al:The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185-191, 2007

13) Gardner MJ, Boraiah S, Helfet DL, et al:Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 22:195-200, 2008

14) Gradl G, Dietze A, Arndt D, et al:Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127:937-944, 2007

15) Hagino H, Fujiwara S, Nakashima E, et al:Case-control study of risk factors for fractures of the distal radius and proximal humerus among the Japanese population. Osteoporos Int 15:226-230, 2004

16) Hodgson SA, Mawson SJ, Stanley D:Rehabilitation after two-part fractures of the neck of the humerus. J Bone Joint Surg Br 85:419-422, 2003

17) 石黒　隆，橋爪信晴，中山　学：上腕骨近位端骨折に対する保存療法．下垂位での早期運動療法．整・災外50：325-332，2007

18) Jakob RP, Miniaci A, Anson PS, et al:Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 73:295-298, 1991

19) 衣笠清人：プレート固定．p107-113(玉井和哉編：上腕骨近位端骨折．適切な治療法の選択のために，金原出版，東京，2010)

20) Lanting B, MacDermid J, Drosdowech D, et al:Proximal humeral fractures. A systematic review of treatment modalities. J Shoulder Elbow Surg 17:42-54, 2008

21) Lefevre-Colau MM, Babinet A, Hayad F, et al:Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. J Bone Joint Surg Am 89:2582-2590, 2007

22) Linhart W, Ueblacker P, Grossterlinden L, et al:Antegrade nailing of humeral head fractures with captured interlocking screws. J Orthop Trauma 21:285-294, 2007

23) Murray IR, Amin AK, White TO, et al:Proximal humeral fractures. Current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 93:1-11, 2011

24) Neer CS II:Shoulder Reconstruction. Philadelphia:WB Saunders;pp363-398, 1990

25) Neer CS II:Four-segment classification of proximal humeral fractures:Purpose and reliable use. J Shoulder Elbow Surg 11:389-400, 2002

26) Owsley KC, Gorezyca JT:Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am 90:233-240, 2008

27) Rüedi TP, Buckley RE, Moran CG:AO Principles of Fracture Management. Second expanded edition. New York:Thieme Publishers;2007

28) Schiuma D, Plecko M, Kloub M, et al:Influence of peri-implant bone quality on implant stability. Med Eng Phys 35:82-87, 2013

29) Sirveaux F, Roche O, Molé D:Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96:683-694, 2010

30) Smith AM, Mardones RM, Sperling JW, et al:Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg 16:14-24, 2007

31) Solberg BD, Moon CN, Franco DP, et al:Locked plating of 3- and 4-part proximal humerus fractures in older patients. The effect of initial fracture pattern on outcome. J Orthop Trauma 23:113-119, 2009

32) 玉井和哉：上腕骨近位端骨折の分類と治療．日整会誌83：999-1009，2009

33) 渡辺安里，小川清久：Kapandji法とその変法．p90-93(玉井和哉編：上腕骨近位端骨折．適切な治療法の選択のために．金原出版，東京，2010)

34) Wilson J, Bonner TJ, Head M, et al:Variation in bone mineral density by anatomical site in patients with proximal humeral fractures. J Bone Joint Surg Br 91:772-775, 2009

35) Yamada M, Briot J, Pedrono A, et al:Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg 16:596-602, 2007

36) 矢野雄一郎，玉井和哉，吉川勝久・他：上腕骨近位骨密度と他部位骨密度の比較．肩関節36：881-883，2012