非限制性人工肩关节置换治疗肩关节和肱骨近端严重病损

目的观察并评估非限制性人工肩关节置换治疗肩关节及肱骨近端严重病损的疗效。方法自1999～2004年共进行11例人工肩关节置换术,患者平均年龄为65岁；肱骨近端复杂四部分骨折6例,陈旧性肱骨解剖颈骨折并脱位3例,肩关节骨关节炎2例。其中对2例肩关节骨关节炎采用非限制性假体全肩关节置换术,对9例复杂肱骨近端骨折采用非限制性假体半肩置换术。所有11个肱骨头假体和2个肩盂假体均使用骨水泥固定。结果所有患者均获得随访,时间为1～4年,平均2．3年。2例复杂骨折患者存在肩关节外旋部分受限和轻度疼痛,其余病例均无疼痛,假体无松动。采用Neer评分和美国矫形外科学会评定标准,术后Neer评分平均为88．7分,评定为满意,肩关节功能满意。结论非限制性人工肩关节置换治疗肱骨近端严重病损疗效可靠、安全,精确的假体安置、软组织修复及术后系统的康复训练是关节功能恢复及降低并发症的关键。     

人工肱骨头置换术治疗老年肱骨近端粉碎骨折

[目的]探讨人工肱骨头置换治疗老年肱骨近端粉碎骨折的疗效。[方法]对26例肱骨近端粉碎骨折老年患者施行人工肱骨头置换术,并进行疗效评定。患者年龄66~82岁,平均75.2岁。10例为三部分骨折,16例为四部分骨折,其中6例伴肩关节半脱位,手术全部采用骨水泥型人工肱骨头假体。[结果]本组26例术后随访6~24个月,平均15个月,按肩关节Neer评分系统进行评价,优13例,良10例,可2例,差1例,优良率88%。[结论]人工肱骨头置换治疗老年肱骨近端粉碎骨折,能有效解除疼痛、重建关节功能,是一种理想的治疗方法。     

肩关节假体置换术后并发症预防及康复指导

肩关节假体置换术按置换范围分为半肩关节(人工肱骨头置换单极与双极 )和全肩关节置换两大类。肩关节假体置换术主要为病人解除肩关节疼痛 ,恢复其功能 ,稳定关节 [1]。适用于难以闭合和手术复位恢复功能的肱骨头粉碎性骨折、肱骨头缺血性坏死、肱骨头肿瘤等。我科 1 998年 1月至 2 0 0 0年 6月 ,对 1 7例病人施行肩关节假体置换术 ,取得满意效果。1　临床资料1 .1　一般资料本组 1 7例 ,男 1 1例、女 6例 ,年龄 2 9～ 76岁 ,平均 5 2 .5岁。根据 AO分型[2 ] :C型骨折伴脱位 1 3例 ,外伸骨折内固定术后坏死 2例 ,肱骨头肿瘤 2例。急诊手术…     

半肩关节置换术治疗肱骨近端严重病损

目的:采用半肩关节置换术治疗肱骨近端严重病损,并评定疗效。方法:共36例。19例成人肱骨近端四分骨折。9例肱骨近端低恶性度骨肿瘤,肱骨头坏死8例。均采用骨水泥固定人工肱骨头置换术治疗。术后功能锻炼。定期X线检查,评估假体稳定性和肩关节功能。随访时间为1～8年,平均5年3个月。结果:1例42岁肱骨近端骨肿瘤患者术后2年出现松动;3例肱骨近端四分骨折患者伴有肩关节外旋部分受限和轻度疼痛。其余病例无痛,无松动,肩关节功能满意。结论:与远期结果有关的因素包括准确的手术适应证的选择,正确的手术方法特别是修复骨缺损和肩袖损伤;选择好假体的大小和厚度以及假体安放位置;另一关键因素为合理的功能锻炼。     

半肩关节置换术治疗肱骨近端严重病损

目的：采用半肩关节置换术治疗肱骨近端严重病损，并评定疗效。方法：共36例。19例成人肱骨近端四分骨折。9例肱骨近端低恶性度骨肿瘤，肱骨头坏死8例。均采用骨水泥固定人工肱骨头置换术治疗。术后功能锻炼。定期X线检查，评估假体稳定性和肩关节功能。随访时间为l～8年，平均5年3个月。结果：l例42岁肱骨近端骨肿瘤患者术后2年出现松动；3例肱骨近端四分骨折患者伴有肩关节外旋部分受限和轻度疼痛。其余病例无痛，无松动，肩关节功能满意。结论：与远期结果有关的因素包括准确的手术适应证的选择，正确的手术方法特别是修复骨缺损和肩袖损伤；选择好假体的大小和厚度以及假体安放位置；另一关键因素为合理的功能锻炼。     

人工肱骨头置换治疗老年肱骨近端复杂骨折11例

目的 分析人工肱骨头置换治疗肱骨近端复杂骨折的适应证及肩关节功能恢复效果.方法 对11例合并肱骨近端骨折采用肱骨头假体置换术,并早期开展肩关节功能锻炼.结果 平均随访时间10个月,总体优良率82%.无一例关节再脱位及手术并发症,患者主观均满意.结论 肱骨头置换治疗老年肱骨近端复杂骨折,术中修复肩袖和大小结节,早期关节功能锻炼,可达到满意治疗效果.     

半肩关节置换术治疗肱骨近端严重病损

目的:采用半肩关节置换术治疗肱骨近端严重病损,并评定疗效.方法:共36例.19例成人肱骨近端四分骨折.9例肱骨近端低恶性度骨肿瘤,肱骨头坏死8例.均采用骨水泥固定人工肱骨头置换术治疗.术后功能锻炼.定期X线检查,评估假体稳定性和肩关节功能.随访时间为1～8年,平均5年3个月.结果:1例42岁肱骨近端骨肿瘤患者术后2年出现松动;3例肱骨近端四分骨折患者伴有肩关节外旋部分受限和轻度疼痛.其余病例无痛,无松动,肩关节功能满意.结论:与远期结果有关的因素包括准确的手术适应证的选择,正确的手术方法特别是修复骨缺损和肩袖损伤;选择好假体的大小和厚度以及假体安放位置;另一关键因素为合理的功能锻炼.     

人工肱骨头置换术治疗严重肩关节病损的临床研究

目的：探讨人工肱骨头置换术治疗严重肩关节病损的适应证、手术技术要点和早期疗效。方法：2004年6月至2008年1月,采用人工肱骨头置换治疗肩关节病损35例,其中肱骨近端复杂骨折28例,肱骨近端骨巨细胞瘤4例,肱骨头坏死3例。所有患者进行8～57个月（平均21个月）的随访,并应用Neer肩关节评分系统进行评定人工关节功能。结果：术后未发生感染、神经损伤、关节脱位和假体周围骨折,无假体松动下沉及断裂。30例患者能较好地完成梳头和穿衣动作,3例较困难,2例不能完成。Neer评分平均为85．5分,90分以上（优）22例,80～89分（满意）8例,70-79分（不满意）5例,满意率为85．7％。结论：在正确选择适应证、掌握手术技术以及合理的术后康复等前提下,人工肱骨头置换治疗肩关节病损是一种可靠的满意的方法,能较好地恢复肩关节功能,缩短疗程。对一部分依从性较差的患者,在恢复肩关节活动度方面仍欠满意,应加强术后关节康复训练的指导工作。     

人工肱骨头置换治疗肱骨近端粉碎性骨折

[目的]探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的临床效果.[方法] 2005年4月～2009年4月29例新鲜肱骨近端粉碎性骨折患者行人工肱骨头置换并关节功能锻炼,术后随访时间平均50个月.对所有患者进行主观评价,同时对活动度进行评估,采用Neer评分标准评估患者疗效.[结果]22例无疼痛,5例偶感疼痛,2例时有疼痛.29例患者肩关节活动范围:前屈上举108.7°:后伸40°;外展82.3°;内收35°;外旋34°;内旋50°.Neer评分平均85.7分;优11例,良14例,可4例,优良率86％.[结论]人工肱骨头置换是一种治疗肱骨粉碎性骨折的有效方法,但手术适应证、假体安置、软组织重建、术后长期康复锻炼对于手术效果具有重要意义.     

人工肱骨头置换治疗老年肱骨近端粉碎性骨折13例

目的观察人工肱骨头置换治疗老年肱骨近端粉碎性骨折的效果及安全性。方法对13例肱骨近端粉碎性骨折实施人工肱骨头假体置换术,术后早期进行肩关节功能锻炼。观察治疗效果。结果 13例患者均获随访12~16个月,依据肩关节Neer评分标准,总体优良率84.62%(11/13)。无1例发生感染,假体松动等手术并发症。结论严格掌握手术适应证,术后早期进行肩关节功能训练,人工肱骨头置换手术治疗老年肱骨近端粉碎性骨折,术后功能恢复优良率高,并发症发生率低。     

人工肱骨头置换术治疗复杂性肱骨近端骨折

[目的]探讨人工肱骨头置换术治疗肱骨近端复杂性骨折的临床疗效.[方法]35例肱骨近端复杂性骨折患者施行人工肱骨头置换术,手术全部采用骨水泥型人工肱骨头假体.手术前后均对患者的肩关节功能进行UCLA评分.[结果]35例患者随访31～63个月(平均52个月),UCLA评分优(34～35分)10例,良(28～33分)21例,中(21～27分)4例,无差病例.术后肩关节活动范围上举(90.6±8.3)°,外旋(64.5±6.5)°,内旋(72.5±5.3)°.病人主观均较满意.所有病例大小结节均愈合,未发现假体松动、感染、脱位等并发症.[结论]严格掌握手术适应证,重建肱骨近端正常解剖和实现大、小结节骨折块的坚强固定,规范的肩关节功能康复锻炼,是人工肱骨头置换术获得满意疗效的关键.     

肱骨近端Neer 3部分或4部分骨折治疗的加速康复研究

目的研究加速康复理念在严重肱骨近端骨折治疗中应用的意义。 方法成都大学附属医院2017年1月至2020年1月应用加速康复方法治疗37例Neer分型属于3部分或4部分骨折的肱骨近端骨折患者,其中采用骨折切开复位内固定术29例（内固定组）、人工肱骨头置换手术8例（关节置换组）。从手术时间、术中出血量、手术操作难度、术后患者骨愈合情况以及术后肩关节功能情况进行对比分析,评估手术治疗疗效并总结手术治疗体会及加速康复经验。 结果内固定组和关节置换组患者在平均手术时间、平均出血量、平均住院时间和引流管放置时间上差异无统计学意义。加速康复理念始终贯穿于术前病情评估、术中细节处理、术后功能锻炼等整个治疗过程中。术后随访,内固定组有27例术后3个月时达到骨愈合,1例因术后2个月时外伤再发骨折行翻修手术,1例发生骨折延迟愈合,予患肢悬吊,术后5个月时达到骨愈合。关节置换组8例患者均在术后3 ~ 4个月达到术后骨性愈合,术后无肩峰骨折及肩胛骨骨折病例。两组患者术后视觉模拟评分无显著差异,内固定组患肢肩关节功能评分在术后3个月、6个月及1年时明显优于关节置换组（P<0.05）。 结论严重的肱骨近端骨折应根据不同的骨折类型选择手术方案。加速康复治疗理念自始至终贯穿于肱骨近端骨折的诊治过程中,对术后疗效影响显著。     

Proximal humeral fractures treated with arthroplasty

P74ro50x%iyme aaolrfs h houulmdm.eer raAalfl t effrrraa cactgtuuerr ee5ss0,ainc wc oopumanteiten nf othsra vomeldo reaer m tthhucaanhnhigher incidence of proximal humeral fractures thanmen.In patients younger than50years old,high-energy trauma is the most common cause of proximalhumeral fractures,and after age50,minimal-to-moderate trauma is the most common cause.1Neer s classification,the most popularclassification system for proximal humeral fractures,isbased on the anatomical relationship o…     

人工肱骨头置换治疗老年肱骨近端三、四部分骨折

目的 探讨老年肱骨近端三、四部分骨折行人工肱骨头置换术的适应证、技术要点及术后康复治疗对肩关节功能恢复的影响.方法 对15例老年肱骨近端三、四部分骨折患者行人工肱骨头置换.术前测量健侧大结节最低点至肱骨头最高点的距离;术中尽量复位大小结节,合理控制假体高度及后倾角度,尽量修复损伤肩袖;术后分3阶段有计划康复治疗.结果 15例均获随访,时间9个月～6年5个月.11例完全不痛,2例肩峰后下方有压痛,1例肩关节上举运动痛,1例有轻度肩关节不稳.Neer评分:优7例,良6例,可2例.结论 对于老年肱骨近端严重三、四部分骨折、特别是有头部粉碎骨折患者行人工肱骨头置换术,只要严格把握手术适应证,遵循肱骨头置换过程中的关键技术方法,有计划进行术后康复训练,可快速恢复肩关节良好的活动功能.     

Vascularized scapular grafting for treatment of osteonecrosis of the humeral head

Eight dissections in four embalmed cadavers were performed to investigate the possibility of vascularized scapular grafting for osteonecrosis of the humeral head. When the angular branch was used as the nutrient vessel, the mean length of the vascular pedicle was 12.4 cm, which was sufficient for transferring the scapula into the humeral head. Based on the anatomical study, a 27-year-old man with corticosteroid-induced osteonecrosis of the right humeral head was treated by vascularized scapular grafting. The pedicled vascularized scapula was successfully transferred into the humeral head using the angular branch. The patient's right shoulder pain disappeared following surgical recovery. He had no limitations of right shoulder motion 3 years after the surgery. Magnetic resonance imaging at 1 year after the surgery indicated revascularization of the humeral head. The humeral head did not collapse during a 3-year follow-up with radiographic evaluation. This procedure has the potential to be a new joint-preserving procedure for osteonecrosis of the humeral head.     

Osteonecrosis of the humeral head: results of replacement

One hundred twenty-seven shoulders treated with replacement arthroplasty for osteonecrosis of the humeral head were reviewed and assessed by mailed questionnaire for results, durability, and complications. These included 71 humeral head replacements and 56 total shoulder replacements. Thirty-six shoulders were lost to follow-up because of death of the patient; an additional 3 shoulders were locking survey follow-up. Thus current follow-up was available for 88 shoulders. At an average follow-up of 8.9 years, subjective improvement was expressed for 70 (79.5%) of the shoulders and no to occasional moderate pain for 68 (77.3%). The mean American Shoulder and Elbow Surgeon score was 63, and the median was 68. Inferior results in American Shoulder and Elbow Surgeon score and range of motion were noted in post-traumatic osteonecrosis, and superior results were noted in steroid-induced osteonecrosis. Little difference was found between humeral head replacement and total shoulder replacement. The most common postoperative complication was rotator cuff tearing, found in 23 (18.1%) of 127 shoulders. This complication was more common in shoulders with a history of any surgery. The cause of osteonecrosis and previous treatment have important implications for the results of shoulder replacement for this disease.     

The reverse shoulder prosthesis for primary and secondary treatment of proximal humeral fractures: a case report

Humeral head fractures are very common among elderly people, often requiring shoulder arthroplasty. One requirement for good function after shoulder arthroplasty is an intact or at least reparable rotator cuff. In patients with multifractured and or osteoporotic tuberosities, refixation leads to the potential risk of redislocation and resorption of the tuberosities or coexisting irreparable rotator cuff tears lead to a high failure rate after implantation of traditional fracture prosthesis, whereas the reverse shoulder arthroplasty may provide better outcome. Here we report of a 79-year-old woman, who fractured both humeral heads at different times. Her right side was treated with a fracture prosthesis, which had to be converted after 2 years to a reverse shoulder prosthesis. Because of coexisting irreversible rotator cuff tear accompanying the second humeral head fracture on her left side, this patient was primarily treated with a reverse shoulder prosthesis. During the most recent follow up, 33 months after reverse shoulder arthroplasty on the left side and 39 months on the right side, the age- and gender-adapted constant score was 88 compared to 59 on the right side. The primary or secondary implantation of the reverse shoulder prosthesis in proximal humeral fractures has to be planned carefully, since long-term results are still lacking and treatment options after failed reverse shoulder arthroplasty are few. Generally, primary implantation of traditional fracture prosthesis is indicated in most cases of humeral head fractures; but in carefully selected cases primary reverse shoulder arthroplasty may be superior and lead to better outcome. Therefore, future research should be conducted to find criteria where the reverse shoulder arthroplasty is indicated as first line treatment of proximal humeral head fractures in elderly patients.     

Prosthetic replacement of the proximal humerus

Eighteen patients had prosthetic proximal humeral replacement with either a metal or ceramic prosthesis. Three replacements were performed for fracture nonunions, five for benign neoplasms, six for low-grade malignancies, and four for high-grade malignancies. Retention of elbow and hand function was good. In five of the 11 ceramic prostheses, failure occurred at the humeral-prosthetic junction even though it was designed for biologic fixation. Ten of 18 prostheses subluxated or dislocated. Twelve of 18 patients have had revision operations. While the revision rate in this initial series was high, valuable experience was gained for further investigations of shoulder arthroplasty.     

Arthroscopically treated proximal humeral fracture malunion

Articles describing the treatment of proximal humerus malunion are limited. Although in most of the cases, shoulder arthroplasty is the treatment of choice, when the articular surface of the humeral head is intact, other techniques can be considered and successfully used as well. Using arthroscopic techniques for proximal humerus malunion treatment is rarely reported in the literature. We could find only a few cases in which arthroscopic subacromial decompression was used to treat greater tuberosity malunion. Arthroscopic debridement and capsulotomy are also considered in the treatment of proximal humeral malunion cases with shoulder joint stiffness. This case report describes the completely arthroscopic treatment of a 4-part proximal humeral fracture malunion associated with pain and restricted range of motion. The main deformity in our case was medially displaced malunited lesser tuberosity that was blocking the internal rotation of the humerus. Isolated displaced lesser tuberosity fractures are rare injuries. Open techniques are usually the treatment of choice. We did not find any reports of arthroscopic treatment of lesser tuberosity malunion as a separate entity or as a component of a proximal humerus malunion. The early result in our case strongly encourages using arthroscopic techniques for lesser tuberosity malunion treatment as well as expanding the indications for shoulder arthroscopy in proximal humerus malunion cases.