【摘要】 目的　探索人工肩关节置换术治疗肱骨近端严重 3～ 4部分骨折方法。方法　本组 4 5例肱骨近端骨折患者 ,男 14例 ,女 31例 ,年龄 31～ 78岁 ,平均 5 6 1± 7 8岁。 9例Neer分型 4部分和 1例 3部分粉碎性骨折行人工肩关节置换术 :单极人工肩关节 8例 ,双极人工肩关节 1例 ,全肩关节置换术 1例。结果　人工肩关节置换术后随访 2个月～ 4年 ,平均 1 3年。 10例患者 8例完全不疼 ,1例肩关节上举运动痛 ,返修术后缓解。 1例腋神经损伤致三角肌瘫痪 ,肩关节不稳。患者活动范围基本正常。除 1例外 ,其余较满意。假体X线片示置位较好 ,未见透亮区、无松动。结论　对于肱骨近端严重 3～ 4部分骨折 ,人工肩关节置换术是一个可望取得良好疗效的治疗方法。术中应尽可能重建大小结节的解剖复位 ,修复肩袖损伤 ,术后积极的功能康复训练有助于功能改善更多还原

【Abstract】 Objective To explore the arthroplasty in the treatment of 3 or 4 parts fractures of the proximal humerus.Methods Forty-five patients with fracture of proximal humerus were treated.Fourteen cases were male and 31 cases were female,age from 31 to 78 years old,average 56 1±7 8 years old.Nine patients with four-part proximal humerus fractures and one three-part committed fracture were treated with shoulder arthroplasty.Eight cases treated with humeral head replacement,1 case with bipolar humeral head replacement,1 case with total shoulder arthroplasty.Results At follow up (mean 1 3 years,range from 2 months to 4 years)8/10 of the patients were completely released pain,1/10 with active elevation motion pain and released post-revision surgery,1/10 active elevation motion pain and released post-revision surgery,1/10 with axillary nerve injury and deltoid muscular paralysis resulting in shoulder joint instability.All of them were rebuilt overall function in every day activities and all satisfied except 1 patient.X rays films show good position of the prosthesis,no signs of transparency or loosing.Conclusion The results of the study indicate that shoulder arthroplasty is a dependable method to restore comfort and function to patients with three-or four-part fracture of the proximal humerus.However,it is helpful for the improvement of the joint function to rebuild the anatomy reduction of the condylars and repair the cuff to the greatest extent during the surgery and have active rehabilitation post-operation.更多还原