• 瀘州醫(yī)學(xué)院附屬醫(yī)院（四川瀘州，646000）1 骨與關(guān)節(jié)外科，2 康復(fù)科;

【摘 要】 目的 探討人工肱骨頭置換治療肱骨近端復(fù)雜骨折的療效。 方法 2005 年1 月－ 2011 年1 月，采
用骨水泥型人工肱骨頭置換治療18 例肱骨近端復(fù)雜骨折。男8 例，女10 例；年齡52 ～ 84 歲，平均71 歲。致傷原因：摔
傷11 例，交通事故傷3 例，砸傷4 例。傷后至入院時(shí)間為2 h ～ 3 d，平均1.5 d。根據(jù)肱骨近端骨折Neer 分型標(biāo)準(zhǔn)：三部
分骨折8 例，四部分骨折7 例，肱骨頭劈裂性骨折3 例。合并肩關(guān)節(jié)半脫位5 例，股骨骨折2 例，橈骨骨折1 例，骨質(zhì)疏松
癥11 例。 結(jié)果 手術(shù)時(shí)間60 ～ 180 min，平均80 min；術(shù)中出血量100 ～ 400 mL，平均200 mL?；颊咝g(shù)后切口均Ⅰ
期愈合，無感染、神經(jīng)及血管損傷等早期并發(fā)癥發(fā)生。16 例患者獲隨訪，隨訪時(shí)間1 ～ 6 年，平均3 年。X 線片檢查示無
假體松動(dòng)、脫位及異位骨化等并發(fā)癥發(fā)生。術(shù)后1 年肩關(guān)節(jié)功能按照Neer 評(píng)分系統(tǒng)進(jìn)行評(píng)價(jià)，獲優(yōu)5 例，良8 例，可2 例，
差1 例，優(yōu)良率81.2%。 結(jié)論 人工肱骨頭置換治療肱骨近端復(fù)雜骨折能有效解除疼痛、重建關(guān)節(jié)功能，尤其適宜于術(shù)
后活動(dòng)要求不高的老年患者。

引用本文： 萬永鮮 ,徐麗麗,魯曉波,張忠杰,葛建華,陳歌,譚美云. 人工肱骨頭置換治療肱骨近端復(fù)雜骨折18 例療效分析. 中國修復(fù)重建外科雜志, 2012, 26(2): 205-207. doi: 復(fù)制

1. McKoy BE, Bensen CV, Hart sock LA. Fractures about the shoulder: conservative management. Orthop Clin North Am, 2000, 31(2): 205-216.
2. Strohm PC, Köstler W, Südkamp NP. Proximal humerus fracture—what to do? Z Orthop Unfall, 2008, 146 (3): 312-317.
3. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evalution. J Bone Joint Surg (Am), 1970, 52(6): 1077-1089.
4. Neer CS 2nd, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg (Am), 1982, 64(3): 319-337.
5. 劉陽, 李正維. 肱骨近端骨折的手術(shù)治療現(xiàn)狀. 骨與關(guān)節(jié)損傷雜志, 2004, 19(2): 135-137.
6. Visser CP, Coene LN, Brand R, et al. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg, 2001, 10(5): 421-427.
7. Gibson JN, Handoll HH, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Data base Syst Rev, 2002, (2): CD000434.
8. Heers G, Torchia ME. Shoulder hemi-arthroplasty in proximal humeral fractures. Orthopade, 2001, 30(6): 386-394.
9. 馬廣文, 李軍, 呂歐, 等. 肱骨近端四部分骨折治療方式的探討. 臨床骨科雜志, 2006, 9(6): 539-541.
10. Phinpatanakul WP, Norris TR. Indications for prosthetic replacement in proximal humeral fractures. Instr Course Lect, 2005, 54: 357-362.
11. Gierer P, Simon C, Gradl G, et al. Complex proximal humerus fractures—management with a humeral head prosthesis? Clincal and radiological results of a prospective study. Orthopade, 2006, 35(8): 834-840.
12. Ahir SP, Walker PS, Squire-Taylor CJ, et al. Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement. J Biomech, 2004, 37(11): 1699-1708.
13. 臧危平, 馬濤, 王偉, 等. 半肩關(guān)節(jié)置換術(shù)治療肱骨近端復(fù)雜骨折療效分析. 中國矯形外科雜志, 2011, 19(4): 280-283.
14. Esen E, Do?ramaci Y, Gultekin S, et al. Factors affecting results of patients with humeral proximal and fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury, 2009, 40(12): 1336-1341.
15. 顧志堅(jiān), 王永剛, 王哲軍, 等. 人工肱骨頭置換治療老年肱骨近端三、四部分骨折. 中國骨與關(guān)節(jié)損傷雜志, 2006, 21(3): 205-206.
16. 廖春來, 王培信, 謝逸波, 等. 老年骨質(zhì)疏松性肱骨近端粉碎性骨折手術(shù)方式的選擇. 中國修復(fù)重建外科雜志, 2009, 23(12): 1443-1446.
17. 王娟, 黃富國. 喙肩韌帶對(duì)肩關(guān)節(jié)前上方穩(wěn)定作用的生物力學(xué)研究. 中國修復(fù)重建外科雜志, 2009, 23(1): 49-51.
18. Kralinger F, Schwaiger R, Farrell E, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg (Br), 2004, 86(2): 217-219.
  1. 1. McKoy BE, Bensen CV, Hart sock LA. Fractures about the shoulder: conservative management. Orthop Clin North Am, 2000, 31(2): 205-216.
  2. 2. Strohm PC, Köstler W, Südkamp NP. Proximal humerus fracture—what to do? Z Orthop Unfall, 2008, 146 (3): 312-317.
  3. 3. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evalution. J Bone Joint Surg (Am), 1970, 52(6): 1077-1089.
  4. 4. Neer CS 2nd, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg (Am), 1982, 64(3): 319-337.
  5. 5. 劉陽, 李正維. 肱骨近端骨折的手術(shù)治療現(xiàn)狀. 骨與關(guān)節(jié)損傷雜志, 2004, 19(2): 135-137.
  6. 6. Visser CP, Coene LN, Brand R, et al. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg, 2001, 10(5): 421-427.
  7. 7. Gibson JN, Handoll HH, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Data base Syst Rev, 2002, (2): CD000434.
  8. 8. Heers G, Torchia ME. Shoulder hemi-arthroplasty in proximal humeral fractures. Orthopade, 2001, 30(6): 386-394.
  9. 9. 馬廣文, 李軍, 呂歐, 等. 肱骨近端四部分骨折治療方式的探討. 臨床骨科雜志, 2006, 9(6): 539-541.
  10. 10. Phinpatanakul WP, Norris TR. Indications for prosthetic replacement in proximal humeral fractures. Instr Course Lect, 2005, 54: 357-362.
  11. 11. Gierer P, Simon C, Gradl G, et al. Complex proximal humerus fractures—management with a humeral head prosthesis? Clincal and radiological results of a prospective study. Orthopade, 2006, 35(8): 834-840.
  12. 12. Ahir SP, Walker PS, Squire-Taylor CJ, et al. Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement. J Biomech, 2004, 37(11): 1699-1708.
  13. 13. 臧危平, 馬濤, 王偉, 等. 半肩關(guān)節(jié)置換術(shù)治療肱骨近端復(fù)雜骨折療效分析. 中國矯形外科雜志, 2011, 19(4): 280-283.
  14. 14. Esen E, Do?ramaci Y, Gultekin S, et al. Factors affecting results of patients with humeral proximal and fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury, 2009, 40(12): 1336-1341.
  15. 15. 顧志堅(jiān), 王永剛, 王哲軍, 等. 人工肱骨頭置換治療老年肱骨近端三、四部分骨折. 中國骨與關(guān)節(jié)損傷雜志, 2006, 21(3): 205-206.
  16. 16. 廖春來, 王培信, 謝逸波, 等. 老年骨質(zhì)疏松性肱骨近端粉碎性骨折手術(shù)方式的選擇. 中國修復(fù)重建外科雜志, 2009, 23(12): 1443-1446.
  17. 17. 王娟, 黃富國. 喙肩韌帶對(duì)肩關(guān)節(jié)前上方穩(wěn)定作用的生物力學(xué)研究. 中國修復(fù)重建外科雜志, 2009, 23(1): 49-51.
  18. 18. Kralinger F, Schwaiger R, Farrell E, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg (Br), 2004, 86(2): 217-219.