人工肱骨头置换治疗老年肱骨近端骨折

Replacement of humeral head prosthesis for older fractures of proximal humerus

目的探讨应用人工肱骨头置换治疗老年肱骨近端骨折的疗效。方法自2000年3月～2003年3月采用三角肌、胸大肌间隙入路行人工肱骨头置换术治疗老年肱骨近端骨折21例,男10例,女11例;年龄62～82岁,平均72.3岁。根据Neer分类,三部分骨折6例,四部分骨折13例,肱骨头劈裂骨折2例。新鲜骨折(受伤后2周内)18例,陈旧骨折3例。术后患肢用三角巾悬吊,第2d拔除引流管并开始行肩部肌肉收缩锻炼,第3d行肩关节被动和辅助下主动的适量外旋和前屈活动,从20°开始,每天增加5°～8°。1周后可在健侧手臂辅助下加大肩关节运动幅度,每天3～4次,每次10～15min,要避免引起疼痛和拉伤关节。术后6周内避免肩关节过度主动屈曲和外展,6周后去除三角巾,加强主动功能锻炼。结果手术时间40～80 min,平均60 min,出血量200～300 ml。术后随访6～36个月,平均14.6个月。所有患者均无感染、神经损伤和假体周围骨折,无假体松动、脱位等并发症。按照SSMH综合评分标准所有患者平均为24.5分,27分以上(优)3例,24～27分(良)14例,14～24分(中)3例,低于14分(差)1例,优良率为86%;21例患者疼痛评分平均为9.3分,功能评分为8.6分,肌力和运动评分为8.2分,术后肩关节活动范围上举为91.6°±7.2°,外旋63°±5.5°,内旋76.6°±2.2°。结论人工肱骨头置换术是?

Objective To evaluate the results and relating factors in the treatment of proximal humeral fractures by replacement of humeral head prosthesis. Methods From March 2000 to March 2003, 21 cases with proximal humeral fractures, which were 10 males and 11 females aging from 62 to 82 years with an average of 72.3 years, were admitted to our hospital. All the patients were underwent one-stage operation of humeral head hemiarthroplasty through the anteromedial approach of shoulder joint. The average operative time was 60 minutes (range, 40 to 80 minutes) with a blood loss ranging form 200 ml to 300 ml. According to Neer classification, 6 cases were three-part fractures, 13 four-part fractures, and 2 head-splitting fractures. There were 18 fresh fractures and 3 old fractures. All the fractures were treated with replacement of humeral head prosthesis. After operation, the upper extremity was immobilized for 6 weeks, however, physical therapy, including pendulum, isometric elbow, and wrist and hand exercises, was begun on the first day after surgery. Results The follow-up ranged from 6 to 36 months with a mean period of 14.6 months. No lessening prosthesis, prosthesis dislocation, postoperative infection, nerve damage or periprosthesis fractures occurred. According to the scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los. Angeles, California, USA) based on shoulder pain, functional status, muscle strength and range of motion, the average score was 24.5. Furthermore, the score was above 27 (excellent) in 3 cases, and 24 to 27 (good) in 14, and the excellent rate was 86%. The average score of pain was 9.3, function 8.6, muscle strength 8.2 in 21 cases. Conclusion Replacement of humeral head prosthesis is a preferable method for the treatment of proximal humeral fractures in the elderly patients, with significant effects in keeping the function and relieving the pain of the shoulder joint postoperatively.