复杂肱骨近端骨折人工肱骨头置换术中肩袖重建的长期疗效观察

目的探讨Neer 3、4部分肱骨近端骨折人工肱骨头置换术中肩袖重建的远期临床效果。方法回顾性分析自2001-01—2012-12采用人工肱骨头置换术治疗的25例Neer 3、4部分肱骨近端骨折。术前测量健侧大结节最低点至肱骨头最高点的距离,术中尽量解剖复位肱骨大、小结节,合理控制假体高度及后倾角度,尽可能修复重建损伤肩袖,术后分阶段康复锻炼。结果本组22例获得有效随访,随访时间平均120(49~190)个月。末次随访时ASES评分为80~92(86.28±3.36)分,肩关节内旋至T10水平,患肢主动前屈上举125°~135°,外旋36°~42°。1例合并臂丛神经损伤者术后肩关节功能恢复满意。结论对于骨折端无法良好复位、肱骨头缺血性坏死可能性大的复杂肱骨近端骨折,人工肱骨头置换同时进行精细的肩袖重建可以获得无痛和良好运动范围的肩关节。

Long term follow up outcome of rotator cuff reconstruction in shoulder arthroplasty for complex proximal humerus fractures

Objective To investigate the long term clinical outcomes of rotator cuff reconstruction in shoulder arthroplasty for Neer 3-part or 4-part proximal humerus fractures.Methods From Jan 2001 to Dec.2012,twenty-five patients with Neer 3-part or 4-part proximal humeral fractures receiving shoulder arthroplasty were analyzed retrospectively.The distance between the lowest point of the great humeral and the highest point of the top of the humeral head were measured preoperatively.During the operation,the great and lesser tuberculum of humerus were reduced as well as possible,with reasonable control of the height of the prosthesis and the rear angle.The tears of rotator cuff were also repaired.After operation,the patients followed a rehabilitation exercise plan.Results Twenty-two patients were well followed up for a mean of 120 months(49-190 months).At latest follow up ASES scores ranged from 80 to 92 points (86.28±3.36 points).Shoulder internal rotation reached T10 level.Positive forward flexion of upper limb ranged from 125 to 135 degrees.Shoulder external rotation was from 36 to 42 degrees.One patient associated with brachial plexus injuries was very satisfied with the recovery of postoperative shoulder joint function.Conclusion The shoulder arthroplasty with fine rotator cuff reconstruction leads to painlessness and excellent range of motion for the complex proximal humeral fractures in case of very poor reduction of fractures or highly possible avascular necrosis of humeral head.