人工肱骨头置换治疗肱骨近端四部分骨折

Hemiarthroplasty in the treatment of four part proximal humeral fractures

目的探讨人工肱骨头置换治疗肱骨近端四部分骨折的临床疗效。方法对46例肱骨近端四部分骨折患者采用人工肱骨头置换治疗，术后三角巾固定3～6（4．2±1．5）周。结果患者住院时间5～16（9．6±2．7）d。患者均获随访，时间12～27（15±3．6）个月。末次随访时优14例，良28例，可3例，差1例，优良率91．3％。随访期间无血管神经损伤、术后感染、脱位、松动等并发症。结论人工肱骨头置换是治疗肱骨近端四部分骨折的有效方法，可以显著缩短康复的时间，减少患者痛苦，改善关节功能。成功与否取决于患者和假体的正确选择、大结节的重建、后倾角的大小、肩袖的修补、精细的手术操作和完善的功能锻炼。

Objective To explore the effect of hemiarthroplasty in the treatment of four-part proximal humeral fractures. Methods 46 patients with four-part proximal humeral fractures were treated by shoulder hemiarthroplasty. Postoperative bandage immobilization was used for 3 ～ 6 （4. 2 ± 1.5 ） weeks. Results The hospital stay was 5 ～ 16 （9. 6 ±2. 7） days. The patients were followed up for 12 -27（ 15 ±3.6） months. At the last follow-up time, the results were excellent in 14 cases, good in 28, fair in 3, and poor in 1, and the excellent and good rate was 91.3%. During the follow-up period, there were no blood vessel and nerve injury, postoperative infection, dislocation, loosening and other complications. Conclusions Shoulder hemiarthroplasty is an efficient treatment for complex proximal humeral factures. It can release pain, restore shoulder function and significantly shorten the recovery time. The success depends on the correct selection of patients and prosthesis, the reconstruction of greater tuberosity, the inclination angle ,the reconstruction of rotator cuff,careful operation and perfect function exercise.