半肩置换治疗肱骨头粉碎骨折疗效分析

目的探讨半肩置换治疗肱骨头粉碎骨折的疗效。方法对18例患者以半肩置换术进行治疗。术后肩关节功能临床评估以Constant-Murley评分和Neer评分为标准，以术后真实前后位等比例X线平片上肩峰、喙突、假体位置、肱骨大结节重建位置之间的关系作为影像学评估参数。术后对患者进行随访。结果17例（94．44％）患者术后肩关节活动时无疼痛或仅有轻度疼痛。最后一次随访时患者肩关节平均内旋至k椎体水平，平均外旋40°，平均前屈126°。Constant-Murley评分为21-98分，平均（69＋19）分。术后Constant-Murley评分头结节间距（HTD）呈负相关，与肱骨偏心距呈正相关。Neer评分结果显示，仅有4例患者对手术结果不满意，满意和非常满意的患者人数分别为5例和9例，且骨折1周内进行手术治疗的患者Neer评分要高于1周后手术的患者。结论骨折后1周内进行手术,肩关节功能恢复得更好。头结节间距和肱骨偏心距是影响半肩置换术后肩关节功能恢复的重要因素．

Objective To explore the curative effect of hemi arthroplasty treatment proximal humeral comminuted fractures and analysis the influence factors.Methods 18 patients with proximal humeral comminuted fractures were treated with hemi arthroplasty from january 2009 to june 2011.Constant-Murley score and Neer score were used as the standard for Clinical evaluation Shoulder joint function after hemi arthroplasty.Acromion／Coronoid process Wosition of prosthesis and position of tuberosities in the postoperative trueAP X-ray of shoulderswere used as radiologieal parameters.Follow up the patients after surgery.Results 17 patients had no ormild shoulder pain or only mild pain.In the last follow up,internal rotation averaged to the L3 level,external rotation averaged 40° and active elevation averaged 126°.Constant-Murley score averaged （69：l：19）.The minimum 21,the highest 98.The head to tuberosity distance was inversely correlated with the same parameters and the humeral of fset was directly correlated with Constant-Mureley seore.Neer score results show that,only 4 patients unsatisfactory,5 satisfactory and 9 very satisfactory.Neer score of the patients operated on with more than one week was below in one week.Conclusion Shoulder joint function recovery of the operated on in one week was better.The head to tuberosity distance and the humeral of fset are important influence factors of Shoulder joint function recovery.