人工肱骨头置换治疗老年肱骨近端三、四部分骨折疗效分析

目的　探讨人工肱骨头置换治疗老年肱骨近端三、四部分骨折的适应症、手术方法及临床疗效。 方法　对采用人工肱骨头置换治疗的39例老年肱骨近端复杂骨折患者进行回顾性分析，其中三部分骨折15例，四部分骨折24例，采用肩关节功能Neer评分及疼痛视觉模拟评分(visual analog scale，VAS)对术后肩关节功能和术后疼痛程度等进行随访对比观察。 结果 本组病例全部得到随访，随访时间 12~32 个月，平均 24 个月，Neer 评分: 优 15 例，良 18例，可 5 例，差1例，优良率 84.6%。 结论　人工肱骨头置换治疗老年肱骨近端三、四部分骨折疗效满意，术中假体的正确植入、肩袖的有效修复、大小结节的正确重建以及个体化的早期关节功能锻炼，是确保术后疗效的关键。

Clinical efficacy analysis of artificial humeral head replacement for treating elderly patients’proximal humeral Neer three-part and four-part fractures

Objective　To discuss the indications, surgical methods andclinical efficacy of treating elderly patients’proximal humeral Neer three-part and four-part fractures.　Methods　39 elderly patients with proximal humeral complex fractures received artificial humeral head replacement were analyzed， retrospectively；Postoperative function of the shoulder joint and degree of pain in 15 cases with three-part fractures and 24 cases with four-part fractures, were assessed using neer score of shoulder joint function and VAS score of pain, respectively.　Results　All patients were followed up with follow-up time ranging from 12 to 32 months, with an average of 24 months; Neer score: 15 cases were optimal, 18 cases were good, 5 cases were moderate, 1 case was bad, the excellent rate being 84.6%.　Conclusion　Artificial humeral head replacement for treating elderly patients’ proximal humeral Neer three-part and four-part fractures can get satisfactory curative effect; the key for guaranteeing postoperative clinical efficacy includes correct prosthesis implantation, effective rotator cuff repair, corrective reconstruction of greater and lesser humeral tubercles in operation and individualized early joint functional exercise.