人工肱骨头置换治疗老年肱骨近端复杂骨折

Artificial humeral head replacement for the proximal humerus complex fracture in elderly patients

目的 探讨应用人工肱骨头置换治疗老年肱骨近端复杂骨折的手术适应证、手术时机、操作要点及术后康复等.方法 选取我院2009年1月至2012年3月收治的老年肱骨近端Neer三、四部分骨折行人工肱骨头置换术患者25例,男15例,女10例;年龄64.0～89.0岁,平均73.6岁.手术中均假体植入得当,准确复位固定大小结节,修复肩袖,术后早期分阶段功能康复锻炼.随访应用Neer肩关节功能评分标准评估疗效.结果 手术时间60～110 min,平均80 min;术后随访9～24个月,平均14个月.所有患者均无感染、假体周围骨折、假体松动等并发症.Neer评分显示优良率84％,患者均能完成日常活动,患者主观满意度为76％.结论 通过严格把握手术适应证,掌握手术时机及操作要点,配合术后积极的功能康复训练,人工肱骨头置换术是治疗老年肱骨近端复杂骨折较满意的方法.

Objective To investigate the experiences of artificial humeral head replacement for treatment of proximal humerus complex fracture in elderly patients,and to discuss the operation indication,operation time,technical points and postoperative rehabilitation.Methods Twenty five elderly patients with proximal humerus Neer three-or four-part fractures,who were hospitalized from Jan.2009 to Mar.2012,were selected to receive artificial humeral head replacement,including 15 males and 10 females,aged 73.6 （64-89） years.All prostheses were implanted precisely,greater and lesser tubercles were accurately reset and fixed,and rotator cuff repaired.The postoperative rehabilitation exercises were strictly performed.Neer＇s scoring system was used to evaluate the treatment results after replacement during the follow-up period.Results The average operation time was 80 （60-110） min.All the patients were followed up for 9 to 24 months after the operation （14 months on average）.No postoperative infection,periprosthesis fracture,prosthesis loosing or prosthesis dislocation was found in all cases.According to Neer score criteria,15 cases were rated as excellent,6 as good and mean in 4 cases,with the excellent and good rate being 84％.All patients could fulfill the daily activities,among them,19 patients were satisfied subjectively,with case satisfaction rate being 76％.Conclusion The artificial humeral head replacement for the proximal humerus complex fracture in elderly patients can quickly restore satisfactory function of the shoulder joints through strict control of operative indication and appropriate operative time,following the technical points,and performing rehabilitation training.