反球型人工肩关节假体置换术治疗复杂肱骨近端骨折

Reverse total shoulder arthroplasty for treatment of complex proximal humeral fractures

目的 探讨反球型人工肩关节假体置换术治疗复杂肱骨近端骨折的临床疗效， 方法 回顾性分析2008年8月至2012年8月采用反球型人工肩关节假体置换术治疗且随访时间≥1年的40例复杂肱骨近端骨折患者资料,男8例,女32例;平均年龄为73.4岁（67～86岁）.主力侧受累24例.新鲜骨折或骨折脱位30例,受伤至手术时间平均为11.4d;骨折根据Neer分型：三部分骨折或骨折脱位5例,四部分骨折或骨折脱位22例,头劈裂3例，陈旧性损伤10例,受伤至手术时间平均为509.0 d;骨折合并锁定脱位7例,陈旧性骨折不愈合或畸形愈合3例， 结果 40例患者术后获平均24.9个月（12 ～ 60个月）随访.末次随访时患者肩关节活动度：前屈上举平均为134.9°,外旋平均为24.7°,内旋平均为第3腰椎水平;疼痛视觉模拟评分平均为0.9分（0～5）分,美国肩肘外科医师评分平均为77.3分（50 ～98分）;Constant评分平均为73.4分（44 ～90分）,加州大学洛杉矶分校评分平均为28.1分（19 ～ 34分）.1例患者术后出现肩峰应力骨折.无感染、假体松动及神经血管损伤等并发症发生， 结论 反球型人工肩关节假体置换术治疗复杂肱骨近端骨折的临床疗效满意,术后大、小结节愈合率较高。

Objective To evaluate the clinical results of reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures.Methods From August 2008 to August 2012,40 consecutive patients underwent reverse total shoulder arthroplasty for the treatment of complex proximal humeral fracture and were followed up for no less than one year.They were 8 men and 32 women with an average age of 73.4 years （range,67 to 86 years）.The dominant side was affected in 24 patients.Of the 30 patients with fresh fracture or fracture-dislocation,the average duration from injury to surgery was 11.4 days; 5 were three-part,22 fourth-part and 3 head-split by the Neer classification.Of the 10 patients with obsolete fracture or fracture-dislocation,the average duration from injury to surgery was 509.0 days; 7 were complicated with locking dislocation,and 3 old fracture nonunion or malunion.Results The mean follow-up time was 24.9 months （range,12 to 60 months）.At the last follow-up,the forward elevation averaged 134.9°,external rotation 24.7° and internal rotation the L3 level.The visual analogue scale （VAS） pain score averaged 0.9 （from 0 to 5）,American Shoulder and Elbow Surgeons （ASES） score 77.3 （from 50 to 98）,Constant-Murley score 73.4 （from 44 to 90）,and University of California at Los Angeles （UCLA） score 28.1 （from 19 to 34）.One patient was found with stress fracture of the acromion postoperatively.There were no complications like infection,prosthetic loosening or neurovascular injury related to the surgery.Conclusion Reverse total shoulder arthroplasty for complex proximal humeral fractures may yield good clinical results with a high healing rate of tuberosities.