采用骨小梁金属假体进行人工肩关节置换治疗复杂肱骨近端骨折  

Primary shoulder arthroplasty for treatment of complex proximal humeral fractures with the trabecular metal prosthesis

作　　者：李奉龙[1] 姜春岩[1] 鲁谊[1] 朱以明[1] 刘心[1] 吴关[1] 

机构地区：[1]北京积水潭医院运动损伤科,北京100035

出　　处：《北京大学学报（医学版）》2012年第6期878-881,共4页Journal of Peking University:Health Sciences

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2009-3-16);首都医学发展科研基金(2009-2062)资助~~

摘　　要：目的:评价采用骨小梁金属假体进行人工肩关节置换治疗复杂肱骨近端骨折的临床疗效。方法:回顾性研究2008年9月至2011年4月收治并获得随访的45例复杂肱骨近端骨折患者资料,男15例,女30例;平均年龄(64.9±10.6)岁(45～85岁);损伤侧别:左侧14例,右侧31例;受伤至手术时间平均(10.2±4.8)d。根据Neer分型,三部分骨折3例,三部分骨折脱位4例,四部分骨折2例,四部分骨折脱位22例,四部分外展嵌插4例,头劈裂10例。45例患者均使用骨小梁金属假体进行人工肩关节置换治疗,其中肱骨头置换39例,全肩关节置换6例。结果:45例患者术后平均随访(18.7±8.1)个月(12～41个月)。末次随访时患者肩关节活动度:前屈上举平均为130.4°±36.5°,外旋平均为37.6°±16.6°,内旋平均为第3腰椎椎体水平(±3个椎体);VAS疼痛评分平均为(0.5±1.2)分(0～4分),ASES评分平均为(81.4±13.9)分(43～100分),Constant-Murley评分平均为(81.6±13.6)分(52～100分),UCLA评分平均为(28.5±5.1)分(16～35分)。患者满意度为95.6%。患者术后拍摄手外旋肩关节正位、侧位和腋位X线片复查,42例患者大结节获得解剖愈合,3例出现大结节不愈合,2例出现肱骨头上移,无感染、假体松动、神经血管损伤等并发症发生。结论:采用骨小梁金属假体进行人工肩关节置换治疗复杂肱骨近端骨折的临床疗效良好,术后大结节骨块愈合率为93.3%。Objective：To evaluate the clinical results of primary shoulder arthroplasty for the treatment of complex proximal humeral fractures with the trabecular metal prosthesis.Methods：In the study,57 consecutive patients with complex proximal humeral fractures underwent primary shoulder arthroplasty with the trabecular metal prosthesis,of whom 45 patients were available for the final follow-up（78.9%）,and were retrospectively assessed.There were 15 men and 30 women with the average age of（64.9±10.6） years（range：45 to 85 years）,and 14 left shoulders and 31 right shoulders were involved.The mean time from injury to surgery was（10.2±4.8） days.According to Neer＇s classification,there were 3 patients with a three-part fracture,4 with a three-part dislocation,2 with a four-part fracture,22 with a four-part dislocation,4 with a four-part valgus-impaction,and 10 with a head splitting.Thirty-nine patients were treated with hemiarthroplasty,and the rest with total shoulder arthroplasty.Results：After a mean follow-up time of（18.7±8.1） months（range：12 to 41 months）,the average range of motion of patients were 130.4°±36.5° for forward elevation,37.6°±16.6° for external rotation and L3 level（±3 vertebrae） for internal rotation.The average VAS pain score,ASES score,Constant-Murley score and UCLA score were 0.5±1.2（0-4）,81.4±13.9（43-100）,81.6±13.6（52-100） and 28.5±5.1（16-35）,respectively.The average patient satisfaction rate was 95.6%.The greater tuberosity healed anatomically in 42 patients,which was confirmed by the post-operative radiographs,while the greater tuberosity nonunion was found in the other three patients.Superior migration of humeral head was found in two patients.There were no complications,such as infection,prosthetic loosening or neurovascular injury,related to the surgery.Conclusion：Primary shoulder arthroplasty for complex proximal humeral fractures with the trabecular metal prosthesis could yield good clinical results.The healing rate of the gre

关 键 词：肱骨骨折 关节成形术 置换 肩关节 骨小梁金属假体 

分 类 号：R683.41[医药卫生—骨科学]