人工半肩关节置换治疗肱骨近端粉碎骨折的疗效及影响因素分析

目的 探讨人工半肩关节置换治疗肱骨近端粉碎骨折的疗效及影响因素.方法 对2000年6月至2006年12月采用半肩关节置换治疗的34例肱骨近端粉碎骨折的患者资料进行回顾性研究.除1例为陈旧性骨折外,其余33例均为新鲜骨折.骨折根据Neer分型:三部分骨折6例,三部分骨折伴肩关节脱位4例,四部分骨折18例,四部分骨折伴肩关节脱位3例,肱骨头劈裂性骨折3例.随访采用Neer评分和视觉模拟(VAS)评分,分析年龄、大小结节重建方法、骨折类型、大小结节愈合质量对肩关节主动上举、主动外旋、Neer评分、VAS评分的影响.结果 所有患者获3～5年(平均3.6年)随访,28例无肩痛,5例偶有轻微肩痛,1例有中度肩痛.Neer评分:优14例,良12例,可7例,差1例,优良率为76.5%;肩关节活动范围平均为:上举100°,外旋30°,内旋L5水平;VAS评分平均3.1分.70岁以下年龄组和70岁以上年龄组在肩关节主动上举活动范围平均值和Neer评分平均值比较差异均有统计学意义(P＜0.05),解剖重建和重叠重建大小结节两组患者的各项指标比较差异均无统计学意义(P＞0.05),不同骨折类型组患者的各项指标比较差异均无统计学意义(P＞0.05),大小结节完全愈合组和大小结节愈合不良或吸收组的肩关节主动上举活动范围平均值比较差异有统计学意义(P=0.003).结论 人工半肩关节置换术治疗肱骨近端严重粉碎性骨折,疗效满意,但应严格掌握适应证.大小结节重建的质量、患者年龄、手术技巧等可以影响疗效.

Treatment of proximal humerus comminuted fractures with semi-shoulder arthroplasty: outcome and affecting factors

Objective To investigate the outcome and affecting factors of the treatment of proximal humerus comminuted fractures with the semi-shoulder arthroplasty. Methods We reviewed 34 patients who had undergone hemiarthroplasty of shoulder between June 2000 and December 2006 for treatment of their comminuted fracture of proximal humerus. All but one fracture were fresh. By Neer classification, 6 cases were three-part fractures, 4 three-part fractures plus shoulder dislocation, 18 four-part fractures, 3 four-part fractures plus shoulder dislocation, and 3 split fractures of humeral head. Neer scoring system was used for follow-up assessment. The effects of age, fracture type, reconstruction and union of tuberosities on active elevation, active external rotation, Neer scores and visual analogue scale(VAS) scores were analyzed. Results The patients were followed up for an average of 3. 6 years (3 to 5 years). Twenty-eight patients reported no shoulder pain, 5 experienced slight pain occasionally, and one had severe pain. The average active shoulder elevation was 110°,external rotation was 30° and internal rotation was at L5. By Neer scoring system, 14 cases were rated as excellent, 12 as good, 7 as fair and one as poor, with an excellent to good rate of 76. 5%. The patients' satisfactory rate was 90%. There were significant differences in active elevation and Neer scores between patients under 70 and patients above 70( P ＜ 0. 05) . There were no significant differences in all indexes between anatomic tuberosity reconstruction and overlapping tuberosity reconstruction( P ＞ 0. 05), as well as between different fracture types ( P ＞ 0. 05). There was a significant difference in active elevation between different union qualities( P = 0. 003) . Conclusions Hemiarthroplasty of shoulder can achieve good results for comminuted fractures of the proximal humerus. The quality of tuberosity reconstruction, quality of tuberosity union and age of the patient may be the main factors that may affect the treatment outcome.