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。

Humeral Head Replacement for Treatment of Severe Shoulder Joint Impairment and Fractures

Objective：To study the indication, surgical techniques and early clinical effect of humeral head replacement for severe shoulder joint impairment and fractures. Methods：From June 2004 to January 2008, 35 patients, including 28 cases of proximal humeral comminuted fractures, 4 cases of giant cell tumor of bone,3 cases of necrosis of humeral head, who underwent humeral head replacement. All patients were followed up for a mean duration of 21 months （range, 8-57months）. The clinical results were evaluated using the Neer scoring system. Results：There was no infection, nerve injury, peri-prosthetic fractures, prosthesis dislocation, sinking, loosening or breaking happened after operation. 32 patients could put on clothes and comb hair properly, but 3 cases with difficult and 2 cases couldn＇t do it. According to Necr scoring system, the average score was 85.5. Score was above 90（excellent） in 22 cases, 80-90（satisfactory） in 8 cases and 70-79（unsatisfactory） in 5 cases, the satisfactory rate was 85.7%. Conclusion：If the choose of indation, surgical technique and postoperative rehabilitation is correct, humeral head replacement is a satisfactory and safe technique for severe shoulder joint impairment and fractures. It can restore the function of the shoulder preferably and shorten the course of treatment. However, recovery of joint motion in some eases with poor compliance is not satisfactory. Therefore, it is necessary to enhance postoperative rehabilitation.