人工肱骨头置换治疗复杂肱骨近端骨折

目的 探讨和分析应用人工肱骨头置换治疗复杂肱骨近端骨折的适应证选择、手术关键以及早期结果。方法 对16例应用人工肱骨头置换治疗的患者进行随访,平均随访时间6．8个月。16例中15例为新鲜骨折,受伤至手术时间平均为8d;1例为骨折术后畸形愈合。患者平均年龄为58．9岁。分别在术后即刻、术后第2、6、10、16周、术后6个月以及最终随访时拍摄X线片。最终随访时应用ASES(American shouder ＆ Elbow Surgeon)评分、Constant-Murley评分、UCIA评分以及SST(Simple Shoulder Test)问卷评估治疗结果。结果 16例ASES评分平均为89．1(64～94),VAS疼痛评分平均为2．7(0～5),肩关节活动度平均为前曲上举128．1^。(90^。～150^。),外旋35．0^。(30^。～40^。),内旋T8～T9水平(Ll～T6);Constant-Murley评分平均为85．7(53～95);UCLA评分平均为30．4(21～33);SST问卷中回答“是”的问题平均为9．3个(7～11个)。对于疼痛的满意度为93．8％,对于功能恢复的满意度为87．5％。结论 通过严格的适应证选择,把握良好的手术时机,精细缜密的手术操作并结合术后长期、完善的康复治疗,应用人工肱骨头置换治疗复杂肱骨近端骨折可得到满意的结果。本文为早期结果报告,仍需进行更长期的随访观察。

Humeral head replacement for the complex treatment of proximal humerus fractures

OBJECTIVE: To investigate indication, technical key during surgery and early results of humeral head replacement for the treatment of complicated proximal humerus fractures. METHODS: Sixteen patients who received humeral head replacement were reviewed with a mean follow-up period of 6.8 months. Of the 16 patients, 15 suffered acute fractures with the mean interval between injury and surgery being 8 days. 1 case was a malunion after ORIF 1 year ago. The mean age for these patients were 58.9 years. Trauma series X-rays were taken at post-operation 2-week, 6-week, 10-week, 16-week 6-month and the latest follow-up. SST (Simple Shoulder Test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest follow-up. RESULTS: The mean ASES score was 89.1 (64 - 94); the mean VAS score was 2.7 (0 - 5); the mean forward flexion was 128.1 degrees (90 degrees - 150 degrees ), external rotation 35 degrees (30 degrees - 40 degrees ), internal rotation at T8-T9 level (L1-T6); the mean Constant-Murley score was 85.7 (53 - 95); the mean UCLA score was 30.4 (21 - 33); the mean number of questions for "yes" in SST questionnaire was 9.3 (7 - 11). The total satisfaction rate for pain relief was 93.8% (15/16), and functional recovery was 87.5% (14/16). CONCLUSIONS: Through strict indication control, appropriate timing, meticulous surgical techniques and long intense rehabilitation, satisfactory results can be obtained in humeral head replacement for the treatment of complicated proximal humerus fractures. Our report is only a preliminary one on early results, and a long-term follow-up data is needed for further evaluation.