反式全肩关节置换术治疗高龄肱骨近端骨折骨不连  

Reverse total shoulder arthroplasty for nonunion proximal humeral fractures in elderly patients

作　　者：贾小林[1] 周明全[1] 胡维[1] 甘强[1] Thomas Stoffels 

机构地区：[1]重庆市中山医院骨科,400013 [2]德国柏林创伤中心骨科,12683

出　　处：《中华关节外科杂志（电子版）》2015年第5期575-578,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨反式全肩关节置换术治疗高龄肱骨近端骨折骨不连的临床疗效。方法对2007年1月至2012年11月在德国柏林创伤中心因肱骨近端骨折骨不连行反式全肩关节置换术术的27例患者进行回顾性研究。男11例,女16例,平均年龄74.9岁。伤后平均11.7个月进行反式全肩关节置换术手术。骨折进行Neer分型,二部分骨折6例,三部分8例,四部分13例。最初的治疗方式包括5例保守治疗,3例闭合复位克氏针固定,19例切开复位钢板内固定。术后常规随访进行Constant评分及影像学检查。结果所有患者平均随访36.8个月(25~65个月)。Constant评分从术前的53.4分增加到术后的82.1分,其中疼痛评分从术前的4.9分升至术后的12.3分(P<0.01)。前屈从术前的41.2°增加到术后的91.7°,外展从32.1°增加到94.3°,外旋从15.9°增加到30.2°,内旋从25.6°增加到55.1°,均有统计学差异(P<0.01)。其中19例术后感觉非常满意,7例感觉满意,1例感觉不满意。没有假体松动发生,但有4例肩胛切迹及8例异位骨化。并发症4例,包括1例一过性腋神经损伤、1例急性感染及2例脱位。结论反式全肩关节置换术是治疗高龄肱骨近端骨折骨不连的有效方法,可以缓解疼痛、改善功能,但术后脱位率较高。Objective To analyze the results of reverse total shoulder arthroplasty used for the treatment of proximal humeral nonunions in the elderly.Methods From January 2007 to November 2012 in Berlin trauma center of Germany, 27 patients who underwent reverse total shoulder arthroplasty for the nonunion of proximal humeral fractures were analyzed, and the mean follow-up period was 36.8 months. The study was consisted of 16 women and 11 men with a mean age of 74.9 years.The average time between the initial fracture and the shoulder arthroplasty was 11.7 months.According to the Neer classification, six cases were two-part fracture, eight cases were three-part fracture, and 13 cases were four-part fracture.The initial treatment consisted of the immobilisation in a sling followed by physical therapy in five patients, the closed reduction and percutaneous Kirschner wire fixation in three patients, and the internal fixation with plates in 19 patients.The clinical and radiologic outcome assessments for all the patients were carried out in the follow-up by Constant score system and radiographic analysis.Results The minimum follow-up time was 25 months (mean, 36.8 months; range, 25-65 months).The mean Constant score increased from 53.4 preoperatively to 82.1 postoperatively ( P<0.01 ) , and the pain score increased from 4.9 to 12.3 (P<0.01) .The average anterior elevation increased from 41.2 °to 91.7 °(P<0.01), the average abduction increased from 32.1 °to 94.3 °(P<0.01), the average external rotation increased from 15.9° to 30.2°(P<0.01) and the average internal rotation increased from 25.6 °to 55.1 °(P<0.01). Nineteen patients were very satisfied, seven patients were satisfied and one patient was not satisfied with the operation.Four patients developed postoperative complications which included transitory axillary nerve palsy ( one case ) , acute infection ( one case ) , and anterior joint dislocation ( two cases ) .All the components were stable although four cases of scapular notching and eight cases of ectopic ossif

关 键 词：关节成形术 置换 肩关节 肩骨折 老年人 

分 类 号：R687.4[医药卫生—骨科学]