人工肱骨头置换术治疗复杂性肱骨近端骨折

Replacement of artificial humeral head prostheses for complex fractures of proximal humerus

[目的]探讨人工肱骨头置换术治疗肱骨近端复杂性骨折的临床疗效。[方法]35例肱骨近端复杂性骨折患者施行人工肱骨头置换术,手术全部采用骨水泥型人工肱骨头假体。手术前后均对患者的肩关节功能进行UCLA评分。[结果]35例患者随访31~63个月（平均52个月）,UCLA评分优（34~35分）10例,良（28~33分）21例,中（21~27分）4例,无差病例。术后肩关节活动范围上举（90.6±8.3）°,外旋（64.5±6.5）°,内旋（72.5±5.3）°。病人主观均较满意。所有病例大小结节均愈合,未发现假体松动、感染、脱位等并发症。[结论]严格掌握手术适应证,重建肱骨近端正常解剖和实现大、小结节骨折块的坚强固定,规范的肩关节功能康复锻炼,是人工肱骨头置换术获得满意疗效的关键。

[Objective]To investigate the clinical effect in treating complex fractures of proximal humerus by using replacement of artificial humeral head prostheses.[Method]Thirty-five patients with complex fractures of proximal humerus were treated with artificial humeral head replacement.All the patients were treated with cemented artificial humeral head prostheses.Shoulder function was graded according to UCLA score before and after operation.[Result]Thirty-five patients were followed up for 31-63（mean,52） months.According to the UCLA score,excellent results（34-35） were obtained in 7,good（28-33） in 15,and fair（21-27） in 3 patients.The activity of shoulder joint was 90.6°±8.3°of raising,64.5°±6.5°of external rotation and 72.5°±5.3°of internal rotation.All the patients had an excellent subjective satisfaction.The greater and the lesser tuberosity were all healed,without prosthesis loosening,infection or dislocations.[Conclusion]The key to get satisfactory effect for artificial humeral head replacement is selecting proper surgical indications,rebuilding normal anatomy of proximal humerus,resuring stable fixation of greater and lesser tuberosity,and practicing dirigation for shoulder joint.