人工半肩关节置换术治疗肱骨头坏死的临床疗效

Clinical effect of artificial semi-shoulder joint replacement in treatment of humeral head necrosis

目的探讨人工半肩关节置换术治疗肱骨头坏死的临床治疗效果。方法收集陆军军医大学第一附属医院2008年2月至2018年1月诊断为肱骨头坏死的患者20例,其中男8例,女12例;左肩7例,右肩13例;年龄45～83岁,平均(67.40±5.06)岁。所有患者均完成至少6个月随访,随访时测量患肢前屈上举角、外展角、外旋角、内旋角,采用ASES评分、UCLA评分、SST评分、VAS疼痛评分对肩关节功能进行评价,并行影像学检查。结果 20例患者术后随访6～37个月,平均(18.50±5.31)个月,其中2例患者肩关节活动时出现轻度疼痛,1例患者患肢出现臂丛神经损伤的临床表现,但在术后第3个月复查已恢复正常;患者术后未出现关节感染、脱位等并发症,在随访期内复查X射线片均提示肩关节假体位置及角度都较好。患肩术前前屈上举、外展、外旋、内旋角度分别是(55.24±8.21)°、(42.58±6.21)°、(12.95±2.74)°、(17.79±3.65)°,末次随访分别是(120.76±13.15)°、(103.08±10.54)°、(33.51±3.14)°、(50.10±7.25)°,末次随访的关节活动度与术前比较差异具有统计学意义(P<0.01);患肩术前ASES评分、UCLA评分、SST评分、VAS疼痛评分分别是(38.24±5.21)、(12.58±3.93)、(3.25±1.42)、(6.79±1.65)分,末次随访分别是(75.74±9.69)、(33.08±4.5)、(9.11±1.85)、(1.45±0.24)分,末次随访的各项评分与术前比较差异具有统计学意义(P<0.01)。结论人工半肩关节置换治疗肱骨头坏死具有肩功能优良率高、并发症少的优点,可明显改善患者患肢功能活动范围及疼痛症状,提高患者生活质量。

Objective To explore the clinical effect of the semi-shoulder arthroplasty in the treatment of humeral head necrosis.Methods Twenty patients with head necrosis of the humerus in first hospital affiliated to army medical university from February 2008 to January 2018 were collected,including 8 cases of males,12 cases of females,7 cases of left shoulder and 13 cases of right shoulder.The patients were aged from 45 to 83 years old,mean(67.40±5.06)years old.All patients were followed up for at least 6 months,the anterior flexion angle,abduction angle,external rotation angle and internal rotation angle of shoulder joint were measured,the function of shoulder joint was evaluated by ASES,UCLA,SST,and VAS,and the imaging examination was conducted.Results All patients were followed up for 6 to 37 months after surgery,with average(18.50±5.31)months,2 patients presented mild pain during shoulder joint activity,1 patient presented brachial plexus nerve damage,but returned to normal 3 months after surgery.No complication happened.X-ray reexamination showed good position and angle of the prosthesis during the follow-up period.The preoperative anteflexion angle,angle of outreach,swing angle and swing angle of the shoulder joint were respectively(55.24±8.21)°,(42.58±6.21)°,(12.95±2.74)°,(17.79±3.65)°,the last follow-up were respectively(120.76±13.15)°,(103.08±10.54)°,(33.51±3.14)°,(50.10±7.25)°,the differences were significant(P<0.01);The preoperative ASES score,UCLA score,SST score,VAS score of the shoulder joint were respectively(38.24±5.21),(12.58±3.93),(3.25±1.42),(6.79±1.65),the last follow-up were respectively(75.74±9.69),(33.08±4.5),(9.11±1.85),(1.45±0.24),the differences were significant(P<0.01).Conclusion Artificial semi-shoulder replacement for the treatment of humeral head necrosis can significantly improve the range of limb function,relieve the pain symptoms of patients and improve patients quality of life,which has excellent and good shoulder function rate and fewer complications.