人工肱骨头置换治疗老年肱骨近端骨折

Artificial Humeral Head Replacement in the Treatment of the Senile Complex Proximal Humerus Fractures

目的分析应用人工肱骨头置换治疗肱骨近端复杂骨折的适应证,以及肩关节功能恢复效果。方法回顾总结37例肱骨近端复杂骨折病例资料。按Neer分型对其中11例四部分骨折伴有肱骨头粉碎者采用人工肱骨头假体置换术,并早期开展肩关节功能锻炼。11例年龄均在60岁以上,其中6例伴肩关节脱位(2例同时合并臂丛神经损伤)。结果11例均获随访6～12个月,平均10个月。Constant Functional Score总体平均评分83,总体优良率82%。无1例发生关节再脱位,无手术并发症,患者主观均满意。结论老年肱骨近端复杂骨折行人工肱骨头置换手术,术中有效修复肩袖和大小结节,结合早期合理关节功能锻炼,可以达到满意的治疗效果。

Objective To investigate the indication of humeral head replacement for the senile complex proximal humerus fractures and early functional recovery of joints shoulder. Methods 37 cases of the complex proximal humerus fractures were retrospectively summarized. Based on NEER system, 11 cases （all of them were above 60y）were typeⅣ fracture with head splitting fracture, among them 6 cases were concomitant with irreducible shoulder dislocation and 2 cases had brachiplex injury. We treated them with prosthetic humeral head replacement operation. Results 11 cases were followed-up at a mean time of 10 months （from 6 to 12）. According to constant functional score system, excellent and good rate was 82 % and population mean score was 83. Neither complication nor shoulder dislocation did happen postoperation. All patients were satisfied with the treatment. Conclusion If rotator cuff is repaired well in operation and earlier exercise and physical treatment be taken, the humeral head replacement operation for the senile complex fracture of proximal humerus would be the best appropriate method.