摘要
目的探讨肱骨近端假体置换术治疗肱骨近端复杂骨折中大小结节的复位与固定方式对提高肩关节功能恢复及减少和预防并发症的影响。方法2004年1月-2007年8月，高龄肱骨近端三部分和四部分骨折脱位患者42例，平均年龄78．5岁，均采用肱骨近端假体置换治疗，其中14例针对该手术中肩袖附带骨（大小结节）的复位并应用Cable-needle内置式环扎“T”形加压固定，13例采用经典Dacron缝线固定，15例应用经典Dacron缝线固定加外置金属带环扎固定。术后依Neer等的康复原则行功能锻炼。结果42例患者均获随访，时间为术后8个月。应用美国肩肘外科医师评分（American Shoulder and Elbow Surgeonss form，ASES）系统进行评价，术后患侧肩关节功能与术前患侧及健侧功能差异均有统计学意义。术后X-P出现大小结节并发症11例，其中5例大小结节吸收，4例大小结节侧方移位（后侧方2例、前侧方2例）；2例单纯大结节上脱位。结论假体置换术治疗肱骨近端复杂骨折，大小结节的复位并应用Cable-needle内置式环扎“T”形加压固定法效果优于其他两种方法；术后功能康复时间表的提前，能够早期有效恢复伤侧肩关节的功能，可有效避免大小结节并发症和提高肩关节功能康复水平。
Objective To investigate effect of tuberosity reduction and fixation during humeral head replacement for treatment of complex proximal humeral fractures on functional recovery of the shoulder joint and on decrease and prevention of complicaitons. Methods From January 2004 to August 2007, 42 elderly patients （ at average age of 78.5 years） with three- or four-part fractures and dislocations of proximal humerus received humeral head replacement. Cable-needle internal implant cerclage T-shape compression fixation was done in 14 patients, classic Dacron needle fixation in 13 and classic Dacron needle fixation plus metal band external implant cerclage fixation in 15. Postoperative exercises were carried out according to Neer＇ s rehabilitation principles. Results All patients were reviewed with the American Shoulder and Elbow Surgeons （ASES） score at the mean follow-up of 8 months postoperatively. Statistical difference of ASES score was found between the postoperative injured shoulder and the preoperative ipsilateral side as well as the uninjured side. Tuberosity complication was found postoperatively at X-P in 11 patients including 5 with absorption of tuberosity, 4 with lateral displacement （2 posterior-lateral position and 2 anterior lateral position） and 2 with supra-subluxation of the head of prosthesis. Conclusions Cable-needle internal implant cerclage T-shape compression fixation during humeral head replacement is better than other two methods and brings about earlier postoperative rehabilitation, which is helpful for functional recovery of the shoulder as soon as possible, prevention of tuberosity complications and improvement of shoulder function rehabilitation level.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2008年第10期799-803,共5页
Chinese Journal of Trauma
基金
基金项目：“十一五”国家科技支撑计划资助项目（2007BAI04B06）
关键词
肩骨折
肩脱位
关节成形术
置换
“T”形加压固定
Shoulder fractures
Shoulder dislocation
Arthroplasty, replacement
T-shaped compression fixation
