人工肱骨头置换术治疗肱骨近端四部分骨折

HUMERAL HEAD REPLACEMENT IN THE TREATMENT OF 4 PARTS FRACTURE OF THE PROXIMAL HUMERUS

目的 为了改善肱骨近端四部分骨折的治疗效果，最大限度地恢复受伤肩关节的功能，对7例肱骨近端四部分骨折病人施行人工肱骨头置换术。方法 假体均选用骨水泥型人工肱骨头。随访5～15个月。采用美国肩肘关节医师协会肩关节评估表对患肩关节进行手术后功能评估。结果 病人主观满意度为89．9％。肩关节疼痛评分为4．5分。主动活动度有明显改善。术后三角肌、肩内旋肌、肩外旋肌力平均为4．6、4．2、4．2分。肩关节功能评分为3．3分。X线片提示，7例人工肱骨头位置均较好，无1例出现假体松动或断柄。结论 人工肱骨头置换术是治疗肱骨近端四部分骨折的一个行之有效的方法。

Objective To improve the result of treatment for 4 parts comminuted fractures of the proximal humerus and to recover maximally the shoulder function. Methods 7 cases with 4 parts fracture of the proximal humerus were managed by humeral head replacement surgery. Among the 7 cases, every prosthesis was fixed with cement. All cases were followed up with a mean duration of 5 - 15 months. The function of the shoulder was evaluated postoperatively according to the methods by American society of Surgeons for Shoulder and Elbow Joints. Resuits The subjective satisfaction of the patients was 89. 8%. The pain score was 4. 5, and range of motion of the shoulder was significantly improved. The strength score of the triceps, internal rotation muscles and external rotation muscles of the shoulder after operation were 4. 6, 4. 2, and 4. 2, respectively. Postoperatively the shoulder joint functional score was 3.3. The position of the prostheses was confirmed to be excellent through radiography, without loosening or stem breakage. Conclusion The replacement therapy of humeral head is an effective method for the management of 4 parts fracture of the proximal humerus.