人工半肩关节置换治疗肱骨近端粉碎骨折

Treatment of comminuted proximal humeral fractures with shoulder hemiarthroplasty

目的探讨半肩关节置换治疗肱骨近端粉碎骨折的临床效果。方法1997年5月-2004年6月，对28例肱骨近端粉碎骨折的患者进行半肩关节置换治疗。平均随访2．1年，并应用美国肩肘外科（ASES）评分进行评估，包括术后疼痛、主动活动范围和日常行动功能。结果28例患者ASES评分平均87．9（67～96）分，其中肩关节活动度平均为：主动前屈上举132°，外旋40°，内旋T10水平，视觉模拟（VAS）疼痛评分平均2．6分。术后6个月，23例患者患侧肌力和功能达到正常的80％，术后1年基本达到正常的90％水平。82％的患者对治疗效果满意。结论只有重建肱骨正常长度、确切固定大小结节和持之以恒的康复锻炼才能使半肩关节置换治疗肱骨近端粉碎骨折获得满意疗效。

Objective To investigate clinical results of shoulder hemiarthroplasty in treating comminuted proximal humeral fractures. Methods Shoulder hemiarthroplasty was performed from May 1997 to June 2004 in 28 cases with comminuted proximal humeral fractures who were followed up for mean 2.1 years. American Shoulder ＆ Elbow Surgeon （ASES） score was adopted for evaluating pain after operation, range of active movement and function of daily work. Results Mean ASES score was 87.9 （67-96 scores） , with mean forward flexion of 132°, external rotation of 40°, mean VAS score of 2.6 and internal rotation at T10 level. Strength and function of 23 cases reached 80% of the normal side six months postoperatively and 90% of the normal side one year postoperatively. Of all cases, 82% were satisfied with the treatment. Conclusion Only reconstruction of normal humeral length, tuberosity fixation and persevering rehabilitation can contribute to a successful result of hemiarthroplasty for the comminuted proximal humeral fractures.