影响人工肱骨头置换手术效果的因素

Factors affecting the outcome of humeral head replacement

目的探讨影响人工肱骨头置换治疗肱骨近端四部分骨折和骨折脱位手术效果的有关因素。方法用人工肱骨头置换方法治疗30例肱骨近端四部分移位骨折和四部分骨折脱位。平均年龄69岁,(43～79岁)。30例均采用骨水泥固定假体。使用单极肱骨头17例,双极肱骨头13例。结果平均随访19个月(12～54个月)。手术侧上肢主动上举平均87°(60°～140°)。UCLA总平均分达到26.4分。ASES平均评分22分。影像学并发症包括3例肱骨大结节位置上移,3例假体后倾位置不良。临床并发症包括1例肩关节僵硬,2例肩袖无力。结论人工肱骨头置换是治疗复杂的肱骨近端四部分骨折和骨折脱位的一种值得推荐的方法。手术技巧、患者年龄、假体选择、手术时机和功能康复治疗影响手术效果。

Objective To investigate involved factors aff ecting the outcome of humeral head re placement in the treatment of 4-part fracture and fracture dislocation of proxima l humerus.Methods 30cases of proximal humeral 4-part f racture and fracture dislocation we re treated with humeral head replacement.The avera ge age was 69years(43～79).All the 30prostheses were fixed wit h cement.Neer type prosthesis was used in 17cases,and bipolar prosthesis in 13cases.Results The follow-up ranged from 12to 54mon ths with an average of 19months.The active elevation of operated arms ra nged from 60°～140°with an average of87°.The total average UCLA score rea ched 26.4points,and the total average ASES score 22points.T he radiographic complications included high position of great tuberosity in 3cases,inadequate retro-version in 3cases.The clinical comp lications included 1case of stiff sh oulder,and 2cases of rotate cuff wea k.Conclusions Humeral head replacement was a valuable option fo r the therapy of proximal humeral 4-p art fracture and fracture dislocati on.Operative technique,the age of the patient,prosthesis choosing,t he time of surgery and rehabilitatio n were factors affecting the outcome of treatment.