单纯人工肱骨头置换术治疗严重肱骨头粉碎骨折

Replacement therapy of humeral head for its severe comminuted fracture

目的 肱骨头粉碎骨折病人用常规的复位固定方法治疗常无法取得良好的疗效。病人常遗留有肩关节疼痛及明显功能障碍。为了改善肱骨头粉碎骨折的治疗效果 ,最大限度地恢复受伤肩关节的功能 ,对 11例肱骨头粉碎骨折病人施行单纯人工肱骨头置换术。方法 手术均在伤后 1周内进行。假体均选用骨水泥型人工肱骨头。平均随访期 9.7个月。采用美国肩肘关节医师协会肩关节评估表对患肩关节进行手术后功能评估。结果 平均手术时间 90min ,平均术中出血量 80 0ml。病人主观满意度为 90 .1%。肩关节疼痛评分为 4.5分。主动活动度有明显改善 :平均外展 90° ,前屈 97° ,外旋 37° ,内旋至L2 水平。术后三角肌、肩内旋肌、肩外旋肌力平均为 4.6、4.2、4.2。肩关节功能评分为 3.2分。X线片提示 ,人工肱骨头位置均较好 ,无一例出现假体松动或断柄。

Objective Conventional reduction and fixation for comminuted fractures of the humeral head generally yields unsatisfactory results, which often lead to shoulder pain and functional disability postoperatively. To improve the result of treatment and to recover maximally the shoulder function, 11 cases of comminuted fractures of the humeral head were managed by humeral head replacement surgery.Methods Among the 11 cases, 4 were males and 7 females. The mean age was 65.9 years old. All the operations were performed within one week after trauma. Every prosthesis was fixed with cement. All cases were followed up with a mean duration of 9.7 months. The function of the shoulder was evaluated postoperatively according to the methods by American society of Surgeons for Shoulder and Elbow Joints.Results The mean operation duration was 90 min, with an average blood loss of 800 ml. The subjective satisfaction of the patients was 90.1%. The pain score was 4.5, and range of motion of the shoulder was significantly improved: abduction to 90°, anterior flexion to 97°, external rotation to 37°, and internal rotation to the level of L2. The strength score of the triceps, internal rotation muscles and external rotation muscles of the shoulder after operation were 4.6, 4.2, and 4.2, respectively. Postoperatively the shoulder joint functional score was 3.2. The position of the prostheses was confirmed to be excellent through radiography, without loosening or stem breakage.Conclusion The replacement therapy of humeral head is an effective method for the management of its comminuted fracture.