一期人工肱骨头置换治疗高龄肱骨近端粉碎性骨折

One-stage artificial humeral head replacement for comminuted proximal humeral fractures in the elderly

目的评价一期人工肱骨头置换在高龄肱骨近端粉碎骨折治疗中的临床效果。方法回顾2010年12月至2014年10月,我院收治的肱骨近端粉碎性骨折病例19例,患者年龄63～85岁,平均71.3岁,其中Neer三部分骨折8例,Neer四部分骨折11例,合并肱骨头脱位7例、臂丛神经损伤3例、同侧桡骨远端骨折2例、同侧股骨颈骨折1例;合并高血压病15例、II型糖尿病13例、陈旧性腔隙性脑梗塞6例。手术于伤后3～7天内进行,全部采用Zimmer公司Bigliani/Flatow水泥型人工肱骨头假体。术后根据Neer康复原则进行早期功能锻炼,平均随访16.3个月,记录疼痛等级、关节活动度,以及有无关节脱位、假体松动、关节周围感染等术后并发症,采用Constant-Murley评分进行功能评价。结果 15例无痛,4例轻微疼痛;无关节脱位、假体松动、关节周围感染等术后并发症。Constant-Murley功能评分：平均70.1分;满意程度：主观满意率78.9%。结论在高龄肱骨近端粉碎性骨折的治疗中,人工肱骨头置换不失为一种良好的选择,它能够快速缓解疼痛、恢复关节功能,但手术适应证、手术时机的把握、以及手术技巧和功能锻炼等是不可忽视的关键。

Objective To evaluate the clinical results of one-stage artificial humeral head replacement in the treatment of comminuted proximal humeral fractures in the elderly. Methods From December 2010 to October 2014, 19 patients with comminuted proximal humeral fractures were adopted and treated, whose mean age was 71.3 years old（ range： 63-85 years）. There were 8 cases of Neer 3-part fractures and 11 cases of Neer 4-part fractures, accompanied by dislocation of the humeral head in 7 cases, brachial plexus injuries in 3 cases, ipsilateral distal radius fractures in 2 cases and ipsilateral femoral neck fracture in 1 case. Hypertension was noticed in 15 cases, type II diabetes in 13 cases and old and lacunar cerebral infarction in 6 cases. All the patients underwent humeral head replacement using the same prostheses of Bigliani / Flatow type produced by Zimmer company at 3-7 days after injuries. Early functional exercise was carried out after the surgery according to the Neer rehabilitation principles. The average follow-up time was 16.3 months. Pain severity and range of motion（ ROM） of the joint were recorded, as well as the complications of dearticulation, prosthetic loosening and periprosthetic joint infections. The postoperative functions were evaluated according to the Constant-Murley scoring system. Results Fifteen patients had no pain and 4 patients had mild pain. No dearticulation, prosthetic loosening or periprosthetic joint infections were found. The mean postoperative functional score was 70.1, and the rate of subjective satisfaction was 78.9%. Conclusions Artificial humeral head replacement is a good choice in the treatment of comminuted proximal humeral fractures in the elderly, which can quickly relieve pain and restore joint function. There are many key factors that cannot be ignored, namely surgical indications, timing and techniques, functional exercise, etc.