半肩假体置换治疗肱骨近端复杂性骨折的应用研究

目的探讨半肩假体置换治疗肱骨近端NeerⅢ和NeerⅣ骨折的临床疗效及手术要点。方法从2005年9月～2010年10月,本组收治了33例肱骨近端复杂骨折的患者,男14例,女19例;年龄62～80岁,平均73.7岁;左侧11例,右侧22例,NeerⅢ13例,NeerⅣ20例,行LINK半肩假体置换治疗。术后应用改良的半肩关节置换评分系统（scoring system-modification for hemiarthroplasty,SSMH）评分和美国肩肘医师评分（American Shoulder and Elbow Surgeon Score,ASES）评价治疗效果。结果 33例患者中均得到随访,随访时间6～55个月,平均28个月。SSMH评分术后1周平均评分14.5分,末次随访（所有患者随访时间均〉6个月）平均评分25.6分,ASES评分术后1周平均评分45分,末次随访平均为84分。结论半肩关节置换是一种治疗肱骨近端复杂性骨折的有效方法,肩袖重建方式、假体与关节盂吻合度、术后功能锻炼是影响疗效的主要因素。

Half shoulder prosthesis treatment for complicated proximal humeral fracture

Objective To investigate the indications, essential techniques in hemiarthroplasty for complicated proximal humeral fractures of Neer Ⅲ and Neer Ⅳ. Methods Septemer, 2005 to October, 2010, 33 cases of complicated proximal humeral fractures were treated by hemiarthroplasty of shoulder prosthesis, including 14 males, and 19 females, with an age range of 62 to 80 years old. There were 13 cases of Neer Ⅲ, 20 cases of Neer Ⅳ. The semi-improved shoulder replacement scoring system （scoring system-modification for hemiarthroplasty, SSMH） and American Shoulder and Elbow Surgeon score （ASES） were used to evaluate the therapeutic effects. Results 33 patients were followed up for 6 months to 55 months, 28 months in average. One week after operation, the SSMH score was 14.5 points in average, and it was 25.6 points at the last follow-up （all patients were followed up for over 6 months）. The average ASES score was 45 points one week after operation, and it was, 84 points at the last follow-up. Conclusions Hemiarthroplasty of the shoulder is an effective way for complicated proximal humeral fracture. The methods of rotator cuff reconstruction, fit of prosthesis and glenoid, and postoperative functional exercise are the main factors affecting the efficacy.