非限制性肩关节置换术

Unconstrained Shoulder Arthroplasty

目的：作者对２９例肩关节炎和肱骨近端骨折患者的３６侧肩关节，采用非限制性假体做全肩关节置换术２４个、半肩（即人工肱骨头）置换术１２个。方法：所有３６个肱骨头假体和１３个肩盂假体为骨长入型非骨水泥假体，余１１个肩盂假体为骨水泥假体。患者术时平均年龄６３岁，术后平均随访６．２年（３．３～１０．４年）。结果：术后肩关节疼痛缓解率达９１．３％，主动活动度增加：前屈４７°、外展４３°、外旋３０°、内旋４个节段。６个日常生活动作能力平均评分由术前０．８分增加到术后３．１分。术后Ｘ线片示肱骨头假体上移８例，其中６例伴有肩袖撕裂甚或缺损。１例肱骨头假体和９例肩盂假体周围可见Ｘ线透亮线。肱骨头假体松动１例；肩盂假体松动２例。

Objective:To evaluate the results of 36 unconstrained shoulder arthroplasties.Methods:24 total and 12 hemi-arthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from osteoarthritis,rheumatoid arthritis and avascular necrosis following proximal fracture of humerus respectively.The average age at surgery was 63 years.Follow-up averaged 6.2 years.Results:Postoperatively,the rate of pain relief was 91.3%,and active range of motion increased by 47°in forward flexion,43°in abduction,30° in external rotation,and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray,proximal migration of the humerus was seen in 8 shoulders,6 of which had either a torn or absen trotat or cuff.Radiolucent line were seen around 1 humeral component and 9 glenoid components,1 humeral and 2 glenoid components loosened.Conclusion:Unconstrained shoulder arthroplasty is a satisfactory and safe technique.