人工肱骨头置换术治疗老年肱骨近端复杂性骨折

Humeral head replacement for treatment of complex proximal humerus fractures

目的探讨人工肱骨头置换术治疗老年肱骨近端复杂性骨折的适应证、手术要点和疗效。方法2000—2006年共行人工肱骨头置换手术治疗老年肱骨近端复杂性骨折23例，骨水泥固定，有计划的康复训练。结果术后19例获得随访，平均1．8年，未发生切口感染、神经损伤、假体周围骨折，1例有半脱位。采用Neer评分系统评定人工关节功能，本组平均82．1分，其中80～89分（满意）17例，70～79分（不满意）2例，满意率为89％，无翻修病例。结论人工肱骨头置换术在严格掌握适应证、重视肩袖和关节稳定结构的重建、有计划的康复训练下，是治疗老年性肱骨近端复杂骨折的一种良好方法。

Objective To discuss the indication, surgical technique and curative effect of humeral head replacement in treatment of complex proximal humerus fracture in old patients. Methods From 2000 to 2006, 23 patients with complex proximal humerus fractures were treated with humeral head replacement and fixated with bone cement in old patients. Rehabilitation training was performed after operation. Results Of all, 19 patients were followed up for average 1.8 years, which showed no infection, nerve injury or periprosthetic fracture except for one patient with semiluxation. NEER score system was used to evaluate the function joint prosthesis. Mean NEER score was 82. 1 points, including 80-89 points （ satisfactory） in 17 patients and 70-79 points （unsatisfactory） in 2, with satisfaction rate of 89%. No patient needed revision. Conclusion With strict indication, active reconstruction of rotating cuff and stable structure of the joint, planned postoperative rehabilitation training, the humeral head replacement is a good method for treating complex proximal humerus fractures in the old patients.