肱骨近端复杂骨折人工肱骨头置换后的肩关节功能:1年随访分析

Shoulder function after humeral head arthroplasty for complex fracture of humerus: 1 year of follow-up

背景:目前众多学者对于治疗肱骨近端复杂骨折的手术方式未能达成共识,且无统一标准,术后肩关节功能的恢复受到多种因素的影响。目的:探讨影响肱骨近端复杂骨折人工肱骨头置换后肩关节功能恢复的相关因素。方法:纳入2012年5月至2017年4月在承德医学院附属医院治疗的53例肱骨近端复杂骨折患者,全部行人工肱骨头置换,随访至术后1年评价患者的肩关节功能情况,并对患者性别、年龄、骨折类型、骨质疏松程度、受伤至手术时间、手术入路、假体位置、大小结节愈合情况、是否应用骨质疏松药物、开始功能练习时间等相关影响因素进行Logistic回归分析。结果与结论:(1)经过1年的随访,Logistic回归分析结果显示,影响肱骨近端骨折经人工肱骨头置换后肩关节功能恢复的因素包括骨质疏松程度、手术入路选择、假体位置情况、大小结节愈合情况、是否应用骨质疏松药物;(2)提示假体位置的选择是人工肱骨头置换术中可控的因素,因此在术中应尽量选择适宜的假体位置;置换前评估患者骨质疏松程度,置换后应用抗骨质疏松药物有助于肩关节功能的恢复;肱骨大小结节愈合有助于肩袖功能的恢复。

BACKGROUND： The surgical methods and treatment criteria for proximal humeral fractures remain controversial. The postoperative recovery of shoulder function is affected by various factors.OBJECTIVE： To explore the factors for the functional recovery of shoulder joint after humeral head arthroplasty for proximal humeral fractures. METHODS： Fifty-three cases of proximal humeral fractures admitted in Affiliated Hospital of Chengde Medical University from May 2012 to April 2017 were included, and all patients underwent humeral head arthroplasty. The shoulder joint function was evaluated at 1 year postoperatively. Logistic regression analysis was carried out on the related factors such as sex, age, type of fracture, degree of osteoporosis, injury to operation time, surgical approach, position of the prosthesis, the healing of greater and lesser tuberosities of humers, adminstration of osteoporosis drugs, and the time of beginning functional exercise. RESULTS AND CONCLUSION： （1） After 1 year of follow-up, Logistic regression analysis showed that the factors affecting the functional recovery of the shoulder joint after arthroplasty were the degree of osteoporosis, surgical approach, position of the prosthesis, the healing of greater and lesser tuberosities of humerus, and the administration of osteoporotic drugs. （2） To conclude, the position of the prosthesis is a controllable factor, so an appropriate position should be chosen as far as possible. Preoperative assessment of the degree of osteoporosis is necessary, and the use of anti-osteoporotic drugs postoperatively contributes to the functional recovery. Additionally, the healing of greater and lesser tuberosities of humers is helpful to the functional recovery of the rotator cuff.