人工肱骨头置换术后大结节影像学改变与肩关节功能  

Relativity analysis between postoperation shoulder function and imaging changes of the greater tuberosity after humeral head replacement

作　　者：姜春岩[1] 朱以明[1] 鲁谊[1] 王满宜[1] 荣国威[1] 

机构地区：[1]北京积水潭医院运动医学科,100035

出　　处：《中华骨科杂志》2007年第7期505-508,共4页Chinese Journal of Orthopaedics

基　　金：北京市科技新星计划资助课题（2004B09）

摘　　要：目的观察新鲜复杂肱骨近端骨折行人工肱骨头置换术后随访X线片上重建大结节影像的动态改变,探讨其原因及其与肩关节功能的关系。方法2002年2月至2005年7月应用人工肱骨头置换治疗新鲜复杂肱骨近端骨折68例,59例术后随访1年以上。男28例,女31例;年龄28～80岁,平均59岁。以随访中肩关节外旋正位X线片上出现大结节影像明显变化的8例为研究组,其余患者为对照组。比较两组的肩关节功能,明确大结节影像改变的临床意义。结果两组术后主动前屈上举角度、主动前屈上举肌力、主动体侧外旋肌力、SST评分以及ASES评分的差异均有统计学意义（P〈0.05）;而主动体侧外旋角度和主动体侧内旋的差异无统计学意义。结论复杂肱骨近端骨折患者应用人工肱骨头置换术后,若随访过程中逐渐出现肩关节外旋正位X线片上大结节影像明显减小甚至消失可能预示肩关节功能恢复不佳。推测造成这种大结节改变的原因是多方面的,其中包括大结节骨块血运差导致的部分骨吸收,以及大结节骨块不愈合导致的骨块进一步移位。Objective Patients with complex proximal humeral fractures treated with humeral head replacements （HHR） were followed. The changes of image of greater tuberosities during follow-up were investigated. The possible reason for such changes of the greater tuberosity and the correlation between the image change of the greater tuberosity and the patients＇ postoperative shoulder function were analyzed. Methods From February 2002 to July 2005, 68 patients with complex proximal humeral fractures were treated with HHR. Among them 59 patients had at least 1 year＇s follow-up, with an average time of 22.2 months. Obvious changes of the greater tuberosities during foUow-up were found in 8 patients. Partial disappearances of the greater tuberosity on AP view of affected shoulder were found in 6 patients, and complete disappearances were found in the other 2 patients. CT scan was used to investigate the exact position of the greater tuberosity. Those 8 patients with image change of the greater tuberosity were defined as resorptive group and the remaining 51 patients were defined as normal group. The shoulder function of two groups were compared with each other with paired t-test. Results Significant differences were found with regard to patients＇ active forward elevation angles （88.8° vs 134.1°, P〈 0.001）, forward elevation forces （0 vs 57.0 N, P〈 0.001）, external rotation forces （22.3 N vs 69.9 N, P〈 0.001）, SST scores （5.8 vs 9.5, P=-0.0001） and ASES scores （59.4 vs 81.3, P〈 0.001） between the two groups. No significant difference was found in active external rotation angle and internal rotation between the two groups. Conclusion In patients with complex proximal humeral fractures treated with HHR, the change of X-ray image of the greater tuberosity in anteroposterior view with shoulder in external rotation may indicate a significant compromised shoulder function. Resorption or displacement of the bony fragment are responsible for this kind of change.

关 键 词：肩关节 关节成形术 置换 放射摄影术 

分 类 号：R686[医药卫生—骨科学]