人工肱骨头置换中使用胸骨针行肱骨近端骨折肩袖重建

背景：越来越多的粉碎、移位严重而无法重建的肱骨近端骨折患者需要行人工肱骨头置换,但此类患者肩袖的重建直接影响治疗效果,置换过程中往往需要良好的肩袖重建。目的：探讨胸骨针在肱骨近端骨折人工肱骨头置换肩袖重建中的应用体会。方法：34例肱骨近端四部分骨折患者行人工肱骨头置换时使用胸骨针修复肩袖,年龄67-78岁。人工肱骨头置换时未过分剥离骨折块与肩袖组织,保留肩袖组织与骨块相连,将胸骨针沿着肩袖大小结节表面肌腱-骨结合部环形缝合备用,可用多根,假体置入后,将肱骨大、小结节及碎骨块解剖复位,收紧胸骨针,大小结节及肩袖附着的碎骨块均原位贴在人工肱骨头下方。术中应尽可能将残余的肩袖和肌肉组织损伤进行缝合修复,并要注意缝合后的动力平衡。采用Neer标准对人工肩关节功能的恢复情况进行评价。结果与结论：34例患者均获随访,随访时间1-3年,24例优,10例良,2例可;无关节脱位、半脱位等关节不稳情况,未见感染、神经损伤及假体松动病例。提示人工肱骨头置换过程中使用胸骨针进行肩袖修复及大小结节固定能使肩袖和大小结节接近解剖位置,并且比常规的涤纶线强度高,固定牢靠,能满足人工肱骨头置换后康复训练的需要,对肩关节的稳定性及功能恢复有重要作用。

Sternum needles for rotator cuff reconstruction of proximal humeral fractures during artificial humeral head replacement

BACKGROUND:More and more patients who have crushing and serious shift proximal humeral fractures that cannot be reconstructed need artificial humeral head replacement. However, the rotator cuff reconstruction may directly affect surgical effect. Thus, better rotator cuff reconstruction is needed during replacement. OBJECTIVE:To investigate application value of sternum needles in rotator cuff reconstruction of proximal humeral fractures during artificial humeral head replacement. METHODS:Thirty-four cases of four-part proximal humeral fractures received rotator cuff repairing with sternum needles during artificial humeral head replacement, at the age between 67 and 78 years. Artificial humeral head replacement was performed without excessive peeling fracture block or rotator cuff tissue to retain the rotator cuff tissue and bone connected, and then the sternum needle was used to ringclosure the nodules along the surface of the rotator cuff tendon-bone junction for reverse, sternum needle could be used more than one. After prosthesis implantation, anatomic reduction of the large and small nodules of humerus and bone fragments was performed, and then the sternum needle was tightened; the large and small nodules and rotator cuff attached bone fragments were affixed to the bottom of the humeral head in situ. Operation should maximally suture the residual rotator cuff and damaged muscle tissue, and should pay attention to the dynamic equilibrium after suture. The recovery of artificial shoulder joint function was evaluated with Neer criteria. RESULTS AND CONCLUSION:All the patients were followed-up for 1-3 years, and the results showed excellent in 24 cases, good in 10 cases and average in two cases. No joint dislocation, subluxation and joint instability, and no infections, nerve injury or prosthesis loosening were observed. Sternum needles for the repairing of rotator cuff and fixation of large and small nodules during artificial humeral head replacement can make the rotator cuff and large and small nodules close to the anatomical location, and the sternum needle has higher strength than conventional polyester line with stable fixation, which can meet the requirement of rehabilitation training after artificial humeral head replacement and play an important role in the recovery of stability and function of the shoulder joint.