半或全肩关节置换治疗肱骨近端严重病损

Hemi or total arthroplasty replacement for severe damages of proximal part of humerus

[目的]探讨采用半或全肩关节置换术治疗肱骨近端严重病损的手术适应证、手术要点以及假体的选择。[方法]选择12例患者,全肩关节置换4例,半肩关节置换8例;肱骨四分骨折6例,肱骨头坏死2例,肱骨头合并关节盂坏死1例,类风湿关节炎合并肩关节强直2例,骨巨细胞瘤1例。采用美国肩肘关节医师协会肩关节评估表对肩关节进行术后功能评估。平均随访14个月。[结果]9例无痛,3例轻微疼痛,12例均无松动,肩关节平均外展100°,10例患者对治疗效果表示满意。[结论]半或全关节置换是一种治疗肱骨近端严重病损的有效方法,成功的关键在于科学的手术治疗方案、适宜的假体和有效的康复计划。

[ Objective] To appraise the indications, essential technical points and selection of prostheses of hemi or total arthroplasty of the shoulder for severe damages of proximal part of humerus. [ Method] Twelve cases had an arthroplasty of the shoulder; 4 total-arthroplasties and 8 hemi-arthroplasties of the shoulder; 6 cases of four parts fractures, 2 cases of humeral head osteonecrosis, 1 case of osteonecrosis of humeral head and glenoid cavity, 2 cases of proliferative arthritis with the shoul- der rigidity, 1 case of bone humor. The function of the shoulder was evaluated postoperatively according to the methods of Amercian Society of Surgeons for Shoulder and Elbow Joints. All cases were followed up with a mean duration of 14 months. [ Result] Twelve cases revealed obvious relief of pain with absence of pain in 8 and mild in 4. Twelve cases had no prosthetic stems loosening. The motion range of the shoulder was improved with a mean abduction of 100. Ten cases had the satisfactory results for treatment. [ Conclusion] Hemi or total arthroplastyof shoulder is effective for complicated proximal humeral damages. The key of success is related with scientific operative method, appropriate selection of prostheses, effective rehabilitation plan.