Huten D, Duparc J
Rev Chir Orthop Reparatrice Appar Mot. 1986;72(8):517-29.
Thirty-four acute and 22 old injuries of the shoulder have been operated on, using either a humeral prosthesis (24 cases) or a total Neer prosthesis (32 cases). The mean age of the patients was 66 years. There were 32 acute and 13 old four-part fractures of the upper end of the humerus and 6 dislocations of the shoulder. The surgical technique and the method of rehabilitation are described. There were 17 post-operative complications, including 4 dislocations, 2 cases of secondary displacements of bone fragments and 2 loosenings of the glenoid component. In only 4 cases was a further operation needed. The results were analysed in 43 cases with a follow-up greater than one year. In 34 cases, there was no pain, but only 17 cases had more than 90 degrees of active flexion. There were no loosenings of the humeral stem. In two cases of humeral replacement, a narrowing of the joint space was noted. There was moderate peri-articular ossifications on 6 occasions. An upward displacement of the prosthesis was noted on 10 occasions, due to rupture of the rotator cuff. The results were much better in acute lesions than in chronic ones. The authors conclude that prosthetic replacement is indicated in severe fractures of the upper end of the humerus, whether acute or chronic, and if the patient is elderly.
34例急性和22例陈旧性肩部损伤接受了手术治疗，采用肱骨假体（24例）或全尼尔假体（32例）。患者的平均年龄为66岁。其中有32例急性和13例陈旧性肱骨上端四部分骨折以及6例肩关节脱位。描述了手术技术和康复方法。术后有17例并发症，包括4例脱位、2例骨碎片继发移位和2例关节盂部件松动。仅4例需要再次手术。对43例随访超过一年的病例进行了结果分析。34例无疼痛，但仅有17例主动屈曲超过90度。肱骨干无松动。在2例肱骨置换病例中，发现关节间隙变窄。有6次出现中度关节周围骨化。因肩袖破裂，有10次发现假体向上移位。急性损伤的结果比慢性损伤好得多。作者得出结论，对于肱骨上端严重骨折，无论急性或慢性，且患者为老年人，均应进行假体置换。
