肱骨近端骨结构性破坏的人工肱骨头假体置换13例分析

Artificial Humeral Head Replacement for the Structural Damage of the Upper End of Humerus in 13 Patients

目的探讨人工肱骨头假体置换治疗肱骨近端病损造成骨质不全疗效的影响因素。方法 2006—2009年我院共对13例肱骨近端病损患者采用定制假体行人工肱骨头假体置换。其中骨巨细胞瘤5例,骨肉瘤2例,动脉瘤样骨囊肿2例,陈旧性部分骨折4例。结果 9例肿瘤患者中1例骨肉瘤患者两年后因远处转移死亡,其余8例患者根据Enneking的骨骼肌肉肿瘤术后功能评分系统对患肢进行评估,最低20分,最高28分,平均24.5分。13例患者患肩活动度:6例巨细胞瘤、骨肉瘤患者前屈25°～50°,平均34°;后伸10°～20°,平均17°;外展10°～60°,平均46°;旋转10°～30°,平均24°。动脉瘤样骨囊肿和骨折共6例肩活动度:前屈40°～90°,平均70°;后伸20°～40°,平均28°;外展40°～110°,平均75°;旋转20°～35°,平均29°。结论人工肱骨头假体置换治疗肱骨近端骨质不全,假体形态、肩袖及关节囊重建及手术时机等均会对疗效造成影响。特别需注意假体的个性化定制及关节囊的重建。

Objective To investigate factors that influence the effectiveness of artificial humeral head replacement for the structural damage of the upper end of humerus.Methods The clinical data of 13 patient who had undergone artificial humeral head replacement for the structural damage of the upper end of humerus in hospital beteen 2005 and 2009 were retrospectively analyzed.The lesions included osteoclastoma （n=5）,osteosarcoma （n=2）,aneurysmal bone cyst （n=2）,and 4-part fracture （n=4）.Results Of the 9 patients with tumors,one patient with osteosarcoma died 2 years after surgery due to distant metastasis,and the remaining 8 patients were evaluated using Enneking′s Musculoskeletal Tumors Features Scoring System,which showed that the lowest score was 20 and the highest score was 28 （mean： 24.5）.Among All the 13 patients,the motions of the diseased shoulders were as follows： anteflexion 34°,rear protraction 17°,abduction 46°,and rotation 24° in tumor patients and anteflexion 70°,rear protraction 28°,abduction 75°,and rotation 29° in non-tumor patients.Conclusion Type of prosthesis,rebuilding of shoulder sleeve and articular capsule,timing of surgery were factors that can affet the outcome of treatment.Special attention should be paid to the customization of prosthesis and the rebuilding of joint capsule.