人工肱骨头置换治疗肱骨近端复杂性骨折

Humeral head replacement 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疗效及技术要点。方法 1997年5月～2010年12月采用人工肱骨头置换骨水泥固定治疗肱骨近端复杂性骨折20例,男性10例,女性10例;年龄38～86岁,平均64.8岁。受伤至手术时间为2～120d,平均12.5d。按照Neer的3个阶段康复训练方法,进行有计划的功能训练。结果术后随访6～120个月,平均28个月。无切口感染、神经损伤、假体周围骨折及脱位并发症。按美国加州大学洛彬矶分校(UCLA)肩关节功能评分标准(Ellman法):优5例(34～35分),良11例(28～33分),中3例(21～27)分,差1例(<21分),优良率80%(16/20)。结论在恰当掌握适应证、正确安置假体、严格的肩袖保护修复技术及完善的康复训练下,人工肱骨头置换术是治疗肱骨近端复杂性骨折的一种有效方法。

Objective To investigate the clinical results and major technical points of humeral head replacement in treatment of complex fractures of the proximal humerus.Methods From May 1997 to Dec.2010,20 patients with complex fractures of the proximal humerus were treated with unipolar humeral head replacement and fixed with bone cement.There were 10 males and 10 females,with the mean age of 64.8 years（ranging from 38 to 86 years）.The time interval from injury to surgery was 2 to 120 days with an average of 12.5 days.Planned exercision was performed after operation,according to Neer three-phase postoperative shoulder rehabilitation program.Results The mean duration of follow-up was 28 months（ranged from 6 to 120 months）,which showed no complications of infection,nerve injury,periprosthetic fractures,dislocation.According to criteria described by Ellman（University of California at Los Angeles,UCLA）,there was excellent（34-35 points） in 5 cases,good（28-33） in 11,fair（21-27） in 3 and poor（21） in 1.The excellent and good rate was 80%（16/20）.Conclusion With proper indication,precise insertion of prosthesis,strict technique of protection and repair for rotation cuff and postoperative rehabilitation training,humeral head replacement is an effective method for treatment of complex fractures of proximal humerus.