以胸大肌肱骨止点确定肱骨假体高度的临床体会

目的探讨胸大肌肌腱肱骨止点(pectoralismajor tendon,PMT)上缘作为半肩置换术中假体高度定位参考的临床应用。方法2014年1月至2014年12月间行切开解剖复位钢板内固定的肱骨近端骨折病例12例,男4例,女8例;年龄56~72岁,平均(65.3±5.2)岁。测量PMT上缘到肱骨头最高点的平均距离为(5.21±0.42)cm。2015年1月至2018年12月的38例老年严重肱骨近端骨折行半肩置换的患者,参照PMT上缘到肱骨头最高点的距离5.2 cm确定肱骨假体高度,男7例,女31例;年龄60~82岁,平均(72.0±6.5)岁。术后3个月拍摄双侧肱骨全长X线片并测量长度,比较双侧差异是否有统计学意义。根据对侧肱骨长度(humeruslength,HL),采用HL×0.176计算PMT到肱骨头最高点距离,与(5.21±0.42)cm比较差异是否有统计学意义。结果所有患者均随访3个月,半肩置换侧肱骨全长与对侧肱骨全长分别为(32.41±2.47)cm、(31.93±2.82)cm,比较差异无统计学意义。根据对侧HL×0.176计算PMT到肱骨头最高点距离为(5.61±2.82)cm,与(5.21±0.42)cm比较差异无统计学意义。结论PMT可以作为肱骨假体高度的可靠参照,PMT上缘到肱骨头最高点距离为(5.21±0.42)cm,可以作为参考数值之一。

Clinical Experience of Using the Upper Border of the Pectoralis Major Tendon Insertion on the Humerus as Reference Mark to Determine the Proper Implant Height in Hemiarthroplasty

Objective To study the practical value of using the upper border of the pectoralis major tendon(PMT)insertion on the humerus as reference mark to determine the proper implant height in hemiarthroplasty for proximal humeral fractures.Methods From January to December 2014,we measured the distance between the upper border of the PMT insertion on the humerus and the top of the humeral head during the open reduction and internal fixationfor fractures of proximal humerus in 12 patients.There were 4 males and 8 females.Theaverage age was(65.3±5.2)years(range,56 to 72 years)The average distance between PMT and the top of the humeral head was(5.21±0.42)cm.From January 2015 to December 2018,5.2cm was used as a reference value to determine the proper implant height in hemiarthroplasty for proximal humeral fractures in 38 older patients.There were males and 31 females.The average age was(72.0±6.5)years(range,60 to 82 years).Three months after surgery,both humerus length were obtained from the X-ray film in same method and compared.Distance between the upper border of the PMT insertion on the humerus and the top of the humeral head were estimated bycontralateral HL×0.176.The length wasofcompared with(5.21±0.42)cm.Results Length of operated humerus and contralateral humerus were(32.41±2.47)cm and(31.93±2.82)cm,no significant difference was found between the both humerus length(P>0.05).Estimated distance between the upper border of the PMT insertion on the humerus and the top of the humeral head was(5.61±2.82)cm.There was no significant difference between(5.61±2.82)cm and 5.20cm.Conclusion The upper edge of the PMT insertion is a reliable reference mark for restoring proper humeral height in hemiarthroplasty for severe proximal humerus fracture in the elderly,the distance between PMT and the top of the humeral head was(5.21±0.42)cm,which is one of the reference values.