肱骨头置换加锚钉线重建肩袖治疗老年Neer四部分肱骨近端骨折

Humeral head replacement and rotator cuff reconstruction with anchor suture for treatment of Neer four-part proximal humeral fractures in the elderly

目的探讨肱骨头置换加锚钉线重建肩袖治疗老年Neer四部分肱骨近端骨折的临床疗效。方法采用肱骨头置换加锚钉线重建肩袖治疗34例老年Neer四部分肱骨近端骨折患者。记录手术情况、末次随访时肩关节活动度,采用Neer评分评价肩关节功能。结果患者均获得随访,时间6~18个月。术后X线片显示,34例肱骨头假体位置良好,肩关节对应关系良好。术后6个月X线片显示,28例大、小结节骨痂形成;6例大、小结节未见骨痂形成,考虑与患者年龄较大、骨质疏松有关。末次随访时,采用Neer评分评价肩关节功能:优12例,良19例,可3例,优良率为91.18%;34例肱骨头假体位置良好,肩关节对应关系良好,肱骨大、小结节均愈合;肩关节活动度:前屈上举84°~110°(97°±13°),水平位内旋68°~86°(77°±9°)、外旋60°~70°(65°±5°)。结论肱骨头置换加锚钉线重建肩袖治疗老年Neer四部分肱骨近端骨折是一种安全、有效的手术方法。

Objective To investigate the clinical effect of humeral head replacement and rotator cuff reconstruction with anchor suture for Neer four-part of proximal humerus fractures in the elderly Methods The 34 elderly patients with Neer four-part proximal humerus fractures were treated with humerus head replacement combined with anchor suture reconstruction of rotator cuff.The operative status and shoulder joint motion of the last follow-up were recorded.The shoulder joint function was evaluated by Neer score.Results All patients were followed up for 6~18 months.Postoperative radiographs showed that 34 cases of humerus head prostheses were in good position,and shoulder joint correspondences were good.Six months after operation,radiographs showed that 28 cases of greater and lesser tubercle callus were formed.There was no callus formation in 6 cases of greater and lesser tubercles,which were considered to be related to the older age of the patients and osteoporosis.At the last follow-up,the shoulder joint function was evaluated by Neer score:12 cases were excellent,19 cases were good,3 cases fair,the excellent and good rate was 91.18%.In 34 cases,the humeral head prostheses were in good position,the shoulder joint corresponded well,and the greater and lesser tubercles were all healed.The shoulder joint activity:anterior flexion was 84°~110°(97°±13°);the internal-rotation was 68°~86°(77°±9°),external-rotation was 60°~70°(65°±5°)at horizontal position.Conclusions Humerus head replacement combined with anchor suture reconstruction of rotator cuff are safe and effective surgical method for the treatment of Neer four-part proximal humerus fractures.