【摘要】 目的:探讨应用人工肱骨头置换治疗老年肱骨近端骨折的疗效。方法:采用三角肌、胸大肌间隙入路行人工肱骨头置换术治疗老年肱骨近端骨折25例,男12例,女13例;年龄60~92岁,平均75.5岁。按Neer分类标准对肱骨近端骨折进行分型:三部分骨折8例,四部分骨折15例,肱骨头劈裂骨折2例。新鲜骨折21例,陈旧骨折4例。术后第3天行肩、肘、腕、手关节的主动或被动练习。结果:手术时间45~90 m in,平均60 m in,出血量200~300 m l。25例手术后均获随访,随访时间1~3年,平均1.5年。所有患者均无感染、神经损伤和假体周围骨折,无假体松动、脱位等并发症。术后根据美国UCLA评分标准:优(34~35分)5例,良(28~33分)16例,中(21~27分)3例,差(0~20分)1例,优良率为84%。术后肩关节活动范围上举为90.5°±6.2°,外旋61.0°±4.5°,内旋75.6°±2.1°。结论:人工肱骨头置换术是治疗老年肱骨近端骨折较满意的方法,手术时间相对较短,术后功能恢复快,能有效减轻肩关节疼痛。更多还原

【Abstract】 Objective:To explore therapeutic effects of artificial humeral head replacement for the treatment of fractures of proximal humerus in senile patients.Methods:Twenty-five patients with fractures of proximal humerus were treated with artificial humeral head replacement.Deltoid muscle and pectoralis major muscle procedure approach were performed in the operation.Among the 25 patients,12 patients were male and 13 female,ranging in age from 60 to 92 years(mean 75.5 years).According to Neer′s classification,8 patients were tris-part fractures,15 patients were quadri-part fractures and 2 patients were split fractures of humeral head.Fresh fractures occurred in 21 patients and old fractures in 4 patients.Initiative and passive exercises of shoulder,elbow,wrist and hand joints performed at the 3st day after operation.Results:The operation time ranged from 45 to 90 minutes,with an average of 60 minutes,ranging in blood loss from 200 to 300 ml.Twenty-five patients were followed up from 1 to 3 years,with an average of 1.5 years.After surgery,there were no complications such as infection,jnjury of nerve,fractures around prosthesis,loose or dislocation of prosthesis.According to scoring system of UCLA,5 patients achieved excellent result(34-35 scores),16 good(28-33 scores),3 fair(21-27 scores) and 1 poor(0-20 scores).The excellent and good rate was 84%.Postoperative motion range of rising shoulder joint was 90.5°±6.2°,external rotation was 61.0°±4.5°,medial rotation was 75.6°±2.1°.Conclusion:Artificial humeral head replacement is a satisfactory method for the treatment of fractures of proximal humerus in senile patients,which possess such advantages as shorter operation time,rapid functional recovery,effective shoulder pain releasing.更多还原