胡元龙

[摘要] 目的 探讨肩关节半关节置换用于治疗肱骨近端复杂性骨折的手术方法与治疗效果。方法 整群收集2013年1月—2014年6月该院收治的肱骨近端复杂性骨折患者84例，随机分为A组与B组，各42例。A组行肩关节半关节置换治疗，B组行肱骨近端锁定钢板内固定治疗，比较分析两组的治疗效果。 结果 A组术后Neer评分及肩关节活动度均显著高于B组（P<0.05）；A组的Neer评分系统优良率为90.48%，显著高于B组的78.57%（P<0.05）；A组无明显并发症，与B组的16.67%比较差异有统计学意义（P<0.05）。结论 肩关节半关节置换用于治疗肱骨近端复杂性骨折具有显著疗效，术后关节功能恢复满意，值得推广应用。

[关键词] 肱骨近端骨折；复杂性骨折；肩关节；半关节置换

[中图分类号] R318 [文献标识码] A [文章编号] 1674-0742（2015）09（a）-0082-03

Treatment of Complicated Proximal Humeral Fractures with Shoulder Hemiarthroplasty and Its Effectiveness

HU Yuan-long

Department of Orthopedics， Harbin Fifth Hospital， Harbin， Heilongjiang Province ，150000 China

[Abstract] Objective To study the treatment of complicated proximal humeral fractures with shoulder hemiarthroplasty and its effectiveness. Methods 84 patients with complicated proximal humeral fractures admitted to our hospital between January 2013 and June 2014 were randomized into group A （n=42） and group B （n=42） to undergo either shoulder hemiarthroplasty or internal fixation using proximal humeral locking plate. The effectiveness of the two methods was compared. Results The postoperative Neer scores and ROM of shoulder were significantly higher in the group A than in the group B， P<0.05； the excellent and good rate according to Neer scores were significantly higher in the group A than in the group B （90.48% vs 78.57%， P<0.05）； no complication was found in the group A， which was significantly different with the group B with complication rate of 16.67%， P<0.05. Conclusion Shoulder hemiarthroplasty is worthy of promotion in treating complicated proximal humeral fractures because of its good effectiveness and satisfactory recovery of joint function.

[Key words] Proximal humeral fracture； Complicated fractures； Shoulder joint； Hemiarthroplasty

肱骨近端骨折是临床常见四肢骨折之一，是指肱骨外科颈及其上方骨折，占全身骨折总数的4%～5%左右[1]。青壮年肱骨骨折多因高能量损伤所致，患者多为粉碎性骨折，伴有严重的骨折移位，在老年人群中发生肱骨近端骨折则多是由于骨质疏松等因素所致，临床治疗难度较大。临床调查研究显示，肱骨近端骨折中有15%～20%的患者为移位、不稳定性骨折，属于复杂性骨折，手术治疗难度较大[2]。切开复位内固定手术虽然具有一定的固定效果，但由于术中为充分暴露骨折断端，需要广泛切开和剥离软组织，可能导致肱骨头血供损害加重，影响术后骨折愈合，增加骨不连以及股骨头缺血坏死风险[3]。近年来，人工肩关节置换术的手术技术以及假体设计获得显著进步，肩关节置管术为肱骨近端复杂性骨折的治疗开辟了新途径。该院对肱骨近端复杂性骨折患者应用肩关节半关节置换术治疗，获得了显著疗效，现报道如下。

1 资料……