肱骨近端粉碎性骨折人工肱骨头置换相关临床解剖因素分析

目的　探讨肱骨近端粉碎性骨折人工肱骨头置换术中假体安装中相关解剖因素及臂丛、旋肱后动脉的解剖特点和意义。 方法　对15例肱骨近端粉碎性骨折患者施行人工肱骨头置换术，术中保护好腋神经、旋肱后动脉并选用适当的假体后倾角、高度、肱骨头的直径正确安装假体。患者平均年龄63.5岁。术后随访并进行Constant评分。 结果　术后随访6~24个月，平均16.2个月，Constant评分平均为80.5分（61~89分）。 结论　人工肱骨头置换术是治疗肱骨近端粉碎性骨折的有效方法，术中掌握相关临床解剖结构特点，有利于减少术后并发症的发生，是临床获得满意疗效的关键。

Clinical and anatomical factor analysis of the proximal humerus fracture in humeral head replacement

Objective　To investigate the clinical and anatomical factors including brachial plexus and posterior humeral circumflex artery in humeral head replacement of the proximal humerus fractures.　Methods 15 patients with displaced 4-part fractures of the proximal humerus were treated. The mean age was 63.5 years. The brachial plexus and posterior humeral circumflex artery were protected and the humeral head were replaced in all patients.　Results　All patients were followed. The mean follow-up period was 16.2 months. The average ConstantScores was 80.5 (range 61-89) in the last follow-up.　Conclusion　Humeral head replacement is an effective therapy for complex fractures of the proximal humerus. Meticulous surgical operation is essential to the prevention of complications and achievement of good results.