人工肱骨头置换治疗肱骨近端骨折18例

Artificial humeral head replacement in the treatment of fractures of the proximal humerus

目的探讨人工肱骨头置换术治疗肱骨近端骨折的手术疗效。方法对18例肱骨近端骨折行人工肱骨头置换，三部分骨折2例，肱骨头劈裂性骨折1例，四部分骨折11例，四部分骨折伴肩关节脱位4例。全部采用骨水泥型假体。结果手术时间60—90min，平均75min，出血量300—400ml，平均350ml。18例随访6～24个月，平均14个月，疼痛明显解除，按半关节成形改良评分系统SSMH综合评分，优6例，良8例，可4例，优良率78％（14／18）。肩关节活动度平均前屈上举99°（62°-164°），外旋40°（24°-50°），内旋至L2水平。1例大结节上移，1例异位骨化，1例假体松动。结论人工肱骨头置换术是治疗肱骨近端骨折有效的办法，能获得满意的关节活动度，并发症发生率低。

Objective To investigate the surgical outcome of artificial humeral head replacement in the treatment of fractures of the proximal humerus. Methods Eighteen patients with fracture of proximal humerus were treated with artificial humeral head replacement. There were 2 cases of three-part fracture, 1 case of head-splitting fracture, 11 cases of four-part fracture, and 4 cases of fracture accompanying dislocation. All the patients were treated with modular cemented prostheses. Results The operation time was 60 -90 min （mean, 75 rain） , and the volume of blood loss was 300 -400 ml （mean, 350 ml）. A follow-up was carried out in the 18 patients for 6 -24 months （mean, 14 months）. All patients were pain-free and satisfied with operation results. According to the SSMH of UCLA, excellent results were obtained in 6 patients, good in 8 patients, fair in 4 patients, the excellent and good rate being 78% （14/18）. The shoulder average forward flexion was 99° （range, 62° - 164°） , average external rotation was 40° （range, 24° -50°） , and internal rotation reached to L2 level. Radiographic analysis revealed superior migration of the greater tubercle in l patient, heterotopic ossification in l patient, and prosthesis loosening in 1. Conclusions Artifical humeral head replacement is an effective therapy for fractures of the proximal humerus, with satisfactory joint range of motion （ ROM ） and low complication rates.