肱骨近端骨折肩关节置换术假体高度确定的解剖学研究

Determination of the proper implant height in hemiarthroplasty for proximal humeral fractures

目的 探讨肱骨近端骨折肩关节置换术中确定假体植入高度的方法.方法 选择成人尸体标本11具,男7具,女4具,共22个肩关节.测量胸大肌肱骨止点上缘至肱骨头关节面顶点的距离（PMT）、大结节高度（HT）及肱骨长度（HL）,计算PMT/HL. 结果 所有标本PMT平均为（5.10±0.54）cm,HT平均为（0.78±0.19）cm,HL平均为（28.9±1.9）cm,PMT/HL的平均值为17.6%.所有标本HL的测量结果均乘以17.6%,分别与其PMT的测量结果比较偏差不超过0.5 cm.PMT、HT、HL左侧和右侧的测量结果差异均无统计学意义（P＞0.05）.PMT和HL的测量结果呈正相关,HT和HL的测量结果无明显相关性. 结论 胸大肌腱止点上缘可作为肱骨近端骨折肩关节置换术中确定假体植入高度的可靠参照.术中可以根据国人PMT的平均值5.10 cm或个体化的数值,即将测量的术前健侧HL乘以固定的系数17.6%来推测患侧PMT,从而决定假体顶点至胸大肌腱肱骨止点上缘的距离.

Objective To discuss how to determine the proper implant height in hemiarthroplasty for proximal humeral fractures. Methods We dissected 22 shoulders of 11 adult cadavers, 7 males and 4females. The distance between the upper border of the pectoralis major tendon insertion on the humerus and the top of the humeral head （PMT）, tuberostiy height （HT） and humeral length （HL） were measured. The PMT/HL value was calculated. Results The average PMT, HT and HL was （5. 10 ± 0. 54） cm,（0. 78 ±0. 19） cm and （28.9 ± 1.9） cm respectively, while the PMT/HL averaged 17.6%. The deviation between HL × 17. 6% and PMT for each shoulder was less than 0. 5 cm. No significant difference was found between the bilateral sides of PMT, HT and HL （ P 〉 0. 05）. Correlation was demonstrated between PMT and HL. There was no correlation between HT and HL. Conclusions The upper edge of the pectoralis major insertion constitutes a reliable reference point for restoring proper humeral height. In clinical practice, the humeral length can be restored by placing the prosthesis 5. 10 cm or the value of contralateral humeral length multiplying 17. 6% above the upper insertion of the pectoralis major.