人工肱骨头置换治疗肱骨近端粉碎性骨折

Humeral Head Prosthesis Replacement for Comminuted Fracture of the Proximal Humerus

目的探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的疗效。方法对8例肱骨近端粉碎性骨折(NeerⅣ型)患者行人工肱骨头置换术,术中同时修复受损的肩袖和关节囊,术后患肩早期进行功能锻炼。结果术后随访6～34个月,病人主观满意度为86.5%,肩关节疼痛评分4.6分,主动活动度:平均外展91°、前屈95°、外旋35°、内旋至L2水平,术后三角肌、肩内旋肌、外旋肌力平均为4.5、4.1、4.2分,肩关节功能评分为3.5分。X线片示肱骨头位置良好,无假体松动或断裂。结论对肱骨近端粉碎性骨折,人工肱骨头置换是一种有效的治疗方法,能明显减少术后肩关节疼痛,最大限度恢复其运动功能。

Objective To investigate the effects of humeral head prosthesis replacement for comminuted fracture of the proximal humerus. Methods According to Neer classification, 8 cases of the comminuted fracture of the proximal humerus were classified type Ⅳ and all were treated with humeral head prosthesis replacement and repair of the injured rotator cuff and joint sac as well. Early rehabilitation was done after surgery. Results With 6 to 34 months follow-up, the subjective satisfaction was 86.5%. The pain scored 4.6 postoperatively, and active range of motion of the shoulder was： abduction to 91°, anterior flexion to 95°, external rotation to 35° ,and internal rotation to L2. The strength score of the triceps, internal rotation and external rotation muscles of the shoulder after operation were 4.5, 4. 1 and 4.2 respectively, the shoulder joint function score was 3.5 postoperatively. Radiograph showed the prosthesis was well-positioned. Conclusion Humeral head prosthesis replacement is effective in the treatment of comminuted fracture of the proximal humerus, by which the postoperative pain can be significantly relieved and joint function can be restored perfectly.