人工肱骨头置换治疗老年肱骨近端三、四部分骨折

目的 探讨老年肱骨近端三、四部分骨折行人工肱骨头置换术的适应证、技术要点及术后康复治疗对肩关节功能恢复的影响.方法 对15例老年肱骨近端三、四部分骨折患者行人工肱骨头置换.术前测量健侧大结节最低点至肱骨头最高点的距离;术中尽量复位大小结节,合理控制假体高度及后倾角度,尽量修复损伤肩袖;术后分3阶段有计划康复治疗.结果 15例均获随访,时间9个月～6年5个月.11例完全不痛,2例肩峰后下方有压痛,1例肩关节上举运动痛,1例有轻度肩关节不稳.Neer评分:优7例,良6例,可2例.结论 对于老年肱骨近端严重三、四部分骨折、特别是有头部粉碎骨折患者行人工肱骨头置换术,只要严格把握手术适应证,遵循肱骨头置换过程中的关键技术方法,有计划进行术后康复训练,可快速恢复肩关节良好的活动功能.

Humeral head replacement in the treatment of 3,4 parts fracture of the proximal humerus in elderly

Objective To explore the elderly proximal humerus 3,4 part fractures of the humeral head arthroplasty indications,techniques and postoperative rehabilitation to restore shoulder function.Methods 15 elderly cases of proximal humeral 3,4 parts fracture patients were performed humeral head replacement.Preoperative measuring health side of the greater tuberosity low to the top of the head of the humerus distance,intraoperative reset size nodules,as far as possible the reasonable control of the false body height and sloping,try to repair the damage rotator cuff,three phase planned postoperative rehabilitation treatment.Results 15 cases have been followed up,followed up for 9~77 months.11 cases were completely not painful,2 cases of joint line after a tenderness,and 1 case lift on shoulder movement,and 1 case with mild pain shoulder instability Neer score standard display,excellent in 7 patients,good in 6,and poor in 2.Conclusions For the old proximal humeral fractures serious 3,4 parts,especially the head shattered fracture patients,the humeral head replacement is expected to get a good curative effect of treatment.In familiar anatomical and shoulder function based on the characteristics of the operation indication,strictly grasp,follow the head of the humerus replacement process the key technology of method,should as far as possible reserves during the greater tuberosity and soft tissue belongs to,close to anatomical reattachment,repair rotator cuff injury.With planned postoperative rehabilitation training,quickly shoulder activities can be restored.