非限制性人工肩关节置换治疗肩关节和肱骨近端严重病损

Unconstrained shoulder arthroplasty for severe damages of shoulder and proximal humerus

目的观察并评估非限制性人工肩关节置换治疗肩关节及肱骨近端严重病损的疗效。方法自1999～2004年共进行11例人工肩关节置换术,患者平均年龄为65岁；肱骨近端复杂四部分骨折6例,陈旧性肱骨解剖颈骨折并脱位3例,肩关节骨关节炎2例。其中对2例肩关节骨关节炎采用非限制性假体全肩关节置换术,对9例复杂肱骨近端骨折采用非限制性假体半肩置换术。所有11个肱骨头假体和2个肩盂假体均使用骨水泥固定。结果所有患者均获得随访,时间为1～4年,平均2．3年。2例复杂骨折患者存在肩关节外旋部分受限和轻度疼痛,其余病例均无疼痛,假体无松动。采用Neer评分和美国矫形外科学会评定标准,术后Neer评分平均为88．7分,评定为满意,肩关节功能满意。结论非限制性人工肩关节置换治疗肱骨近端严重病损疗效可靠、安全,精确的假体安置、软组织修复及术后系统的康复训练是关节功能恢复及降低并发症的关键。

Objective To evaluate the outcome of unconstrained shoulder arthroplasty in treatment of severe damages of shoulder and proximal humerus. Methods Eleven cases of unconstrained shoulder arthroplasty were carried out in our department from 1999 to 2004. The average age of the 11 patients was 65 years. Nine cases underwent hemi-arthroplasty for their complex fractures of proximal humerus with unstrained protheses and two cases received total shoulder arthroplasty for their shoulder osteoarthritis. Cemented prostheses were used in all the cases. Results Follow-ups averaged 2. 3 years. Two cases of four-part fractures reported slight pain and limited external rotation of the shoulder after operation, while there was no pain or loosening of prosthesis in all the other cases who recovered full range of motion. Conclusion Unconstrained shoulder arthroplasty is a satisfactory and safe technique for severe damages of proximal humerus.