摘要
目的探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的疗效及技术要点。方法2001年1月至2004年6月，对21例肱骨近端四部分骨折患者行人工肱骨头置换术，男12例，女9例；年龄45-72岁，平均64．6岁。患者均于受伤后2周行人工肱骨头置换术，使用单极人工肱骨头假体骨水泥固定。68个国人肱骨近端骨标本，男36个，女32个；年龄41-58岁，平均47．9岁；均无骨性疾病。分别测量肱骨头后倾角和肱骨头最高点至大结节最高点的垂直距离。结果术后随访1．5-5年，平均3．9年。X线片显示，肱骨头假体位置均满意，2例术后假体近端周围即出现透亮带，但临床无松动迹象。16例患者无疼痛，4例偶感肩部疼痛，1例时常伴肩部疼痛。所有患者上肢肌力均基本正常，日常活动无困难。按Neer评分标准，优7例，良11例，可3例，优良率86％。评价为可的3例中，2例患者上举受限，经理疗和功能锻炼后症状无明显改善；1例患者肩部上举疼痛，服用非甾体抗炎药结合理疗后疼痛好转，对日常生活和睡眠无明显影响。无肩部感染、肩关节不稳、神经损伤等并发症。国人肱骨近端骨标本的肱骨头后倾角，左侧26．59°±1．36°，右侧26．85°±1．61°；肱骨头最高点至大结节最高点的垂直距离：左侧（6．63＋1．13）mm，右侧（6．80＋1．02）mm。结论应用人工肱骨头置换术治疗肱骨近端四部分骨折疗效满意。术中大结节和肩袖的重建是术后关节功能好坏的重要因素。将假体安放于恰当的位置（人工肱骨头的最高点至肱骨大结节最高点的垂直距离应为6-8mm，人工肱骨头的后倾角应在30°-35°）及适当的早期功能锻炼是手术成功的关键。
Objective To explore the clinical results and technical outlines of humeral head replacement in treating comminuted fractures of the proximal humerus. Methods From January 2001 to June 2004, 21 patients with 4-part fractures of the proximal humerus were treated with humeral head replacement, which included 12 males and 9 females, with the mean age of 64.6 years （ranged from 45 to 72 years）. The surgeries were performed after injury 2 weeks. The posterior slope angle of the humeral head and vertical distance between vertex of the humeral head and vertex of great tuberosity were measured in 68 proximal humeri of Chinese adult cadaver （36 males and 32 females） at the same time. Results The mean duration of follow-up was 3.9 years （ranged from 1.5 to 5 years）. According to Neer scoring system, 7 cases were rated as excellent, 11 as good and 3 as fair. The good and excellent rat was 86%. In 3 fair cases, 2 cases complained limited abduction of shoulder. 1 case complained shoulder pain. No infection, shoulder instability and nerve damage were found in all cases. The mean posterior slope angle of the humeral head of Chinese cadaver was 26.59°±1.36° in left and 26.85°±1.61° in right. The mean vertical distance between vertex of the humeral head and vertex of great tuberosity was （6.63±1.13） mm and （6.80±1.02） mm. Conclusion Satisfactory results can be obtained in humeral head replacement for treatment of 4-part fractures of the proxi- mal humerus. The important factors of shoulder function recovery are the reconstruction of the great tuberosity and rotate cuff during the surgery. The key points to successful surgery are precise insertion of prosthesis （the vertical distance between vertex of prosthesis and vertex of the great tuberosity should be 6-8 mm, and the posterior slope angle of the humeral head should be 30°-35°） and adequate early exercise.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第10期739-742,共4页
Chinese Journal of Orthopaedics
关键词
肩骨折
关节成形术
置换
人工关节
Shoulder fractures
Arthroplasty, replacement
Joint prosthesis
