人工肱骨头置换治疗高龄肱骨近端粉碎性骨折

目的 探讨高龄肱骨近端粉碎性骨折, 人工肱骨头置换的方法、疗效、适应症.方法 回顾2009年3月至2016年8月, 根据Neer分类肱骨近端三、四部分骨折及脱位患者共17例行Ⅰ期人工肱骨头置换, 年龄6479岁, 平均70.2岁, 手术入路皆采用三角肌-胸大肌间隙入路, 术后根据患者术前评估及术中情况制定个性化康复计划行功能恢复.结果 17例均获得随访829月, 平均14.7月, 无感染, 无神经损伤, 无假体松动、下沉、脱位, 1例发生异位骨化, 根据Neer评分标准:优6例, 良8例, 可3例, 优良率82.3%.结论 应用人工肱骨头置换治疗高龄肱骨近端粉碎性骨折疗效满意, 但术前评估, 术中大结节和肩袖的重建, 术后个性化的康复训练是功能恢复的重要因素.

Artificial Humeral Head Replacement in Advanced Aged Cases with Comminuted Fractures of the Proximal Humerus

Objective To study the senile proximal humeral comminuted fracture, the method curative effect and indications of artificial humerus head replacement.Methods From March 2007 to August 2013, a total of 17 cases, according to Neer classified three or four parts of proximal humeral fracture and dislocation patients Ⅰperiod artificial humeral head replacement, aged 64-79, the average age of 70.2 years, surgical approach all USES the deltoid muscle pectoralis major clearance into the road, according to preoperative and intraoperative situation patients were given individualized rehabilitation plan line functional recovery.Results 17 cases were followed up for 8-29 months, an average of 14.7 months, there was no infection, no nerve injury, no dislocation, no prosthesis loosening, sinking, 1 case of heterotopic ossification, according to Neer criteria:6 cases were excellent, 8 cases were good, 3 cases fwere easible, the excellence and good rate was 82.3%.Conclusion The application of artificial humerus head replacement in the treatment of senile proximal humeral comminuted fracture has good curative effect, but preoperative assessment, intraoperative reconstruction of cuhk nodules and rotator cuff, postoperative rehabilitation training of individuation are important factors of functional recovery.