肱骨假体置换Cable-needle内置式环扎"T"形加压固定大小结节治疗肱骨近端骨折

目的 探讨肱骨近端假体置换术治疗肱骨近端复杂骨折中大小结节的复位与固定方式对提高肩关节功能恢复及减少和预防并发症的影响. 方法 2004年1月-2007年8月,高龄肱骨近端三部分和四部分骨折脱位患者42例,平均年龄78.5岁,均采用肱骨近端假体置换治疗,其中14例针对该手术中肩袖附带骨(大小结节)的复位并应用Cable-needle内置式环扎"T"形加压固定,13例采用经典Dacron缝线固定,15例应用经典Dacron缝线固定加外置金属带环扎固定.术后依Neer等的康复原则行功能锻炼. 结果 42例患者均获随访,时间为术后8个月.应用美国肩肘外科医师评分(American Shoulder and Elbow Surgeons's form,ASES)系统进行评价,术后患侧肩关节功能与术前患侧及健侧功能差异均有统计学意义.术后X-P出现大小结节并发症11例,其中5例大小结节吸收,4例大小结节侧方移位(后侧方2例、前侧方2例);2例单纯大结节上脱位. 结论 假体置换术治疗肱骨近端复杂骨折,大小结节的复位并应用Cable-needle内置式环扎"T"形加压固定法效果优于其他两种方法;术后功能康复时间表的提前,能够早期有效恢复伤侧肩关节的功能,可有效避免大小结节并发症和提高肩关节功能康复水平.

Treatment of proxlmal humeral fractures with Cable-needle internal implant cerclage T-shaped compression fixation of tuberosity during humeral prosthesis replacement

Objective To investigate effect of tuberosity reduction and fixation during humeral head replacement for treatment of complex proximal humeral fractures on functional recovery of the shoul-der ioint and on decrease and prevention of complieaitons. Methods From January 2004 to August 2007,42 elderly patients(at average age of 78.5 years)with three-or four-part fractures and dislocations of proximal humerus received humeral head replacement.Cable-needle interual implant cerclage T-shape compression fixation was done in 14 patients.classic Dacron needle fixation in 13 and classic Dacron nee-die fixation plus metal band extemal implant cerclage fixation in 15.Postoperative exercises were carried out according to Neer's rehabilitation principles. Results All patients were reviewed with the Ameri-can Shoulder and Elbew Surgeons(ASES)score at the mean follow.up of 8 months postoperatively.Sta-tisticaI difierence of ASES score was found between the postoperative iniured shoulder and the preoperative ipsilateral side as well as the uninjured side.Tuberosity complication was found postoperatively at X-P in ll patients including 5 with absorption of tuberosity.4 with lateral displacement(2 posterior-lateral posi-tion and 2 anterior lateral position)and 2 with supra.subluxation of the head of prosthesis. Conclu-sions Cable-needle internaI implant cerclage T-shape compression fixation during humeral head replace-ment is better than other two methods and brings about earlier postoperative rehabilitation.which is help-ful for functional recovery of the shoulder as soon as possible.prevention of tuberosity complications and improvement of shoulder funotion rehabilitation level.