Chen Wei-Min, Zhang Xue-Jun, Wang Wei-Jun, Wang Chen
Department of Orthopaedics, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
Zhongguo Gu Shang. 2022 Oct 25;35(10):1000-3. doi: 10.12200/j.issn.1003-0034.2022.10.018.
To evaluate methods of reduction using fragments of the greater tuberosity, and determine the clinical efficacy of humeral head replacement prosthesis height for proximal humerus fractures.
A retrospective study of patients with proximal humerus fractures who were treated and followed up from January 2015 to December 2019, 19 patients met the indications for humeral head replacement, including 7 males and 12 females;8 on the left side and 11 on the right side. The age ranged from 58 to 84 years old with an average of (71.5±5.8 ) years old. The time from injury to operation 3 to 18 d with an average of (7.9±4.3) d. According to Neer's classification, there were 2 cases of three-part fractures with dislocations and 17 cases of four-part fractures, including 6 cases with dislocation and 2 cases with head splits. All 19 patients used the modular prosthesis. The greater tuberosity fracture fragments were reduced to determine the distance from the apex of the greater tuberosity to the humerus marking point. This distance was used as the standard for the height of the prosthesis. One year after the operation, the Constant-Murley score and the University of California, Los Angeles (UCLA) shoulder score were used to evaluate the functional status of the shoulder joint and patient satisfaction.
The 19 patients were followed up from 12 to 58 months with an average of (31.9±14.2) months. The length of the upper arm was 26 to 32 cm after the operation, two-sided comparison error <0.5 cm. Anteroposterior and lateral X-ray films of the shoulder joint at 3 months after operation showed that the fracture fragments were all healed. After one year follow-up, the Constant-Murley score was 80.8±8.9, and the UCLA score was 27.9±4.8. Patient satisfaction rate was 89.5%(17/19).
The greater tuberosity fracture fragments reduction technique, which use the distance from the apex of the greater tuberosity of humerus to the humeral marking point as the standard for the height of the prosthesis, is a simple and effective way with good outcomes in shoulder hemiarthroplasty for treatment of proximal humerus fractures.
评估使用大结节碎片进行复位的方法，并确定肱骨近端骨折人工肱骨头置换假体高度的临床疗效。
回顾性研究2015年1月至2019年12月接受治疗并随访的肱骨近端骨折患者，19例符合人工肱骨头置换指征，其中男性7例，女性12例；左侧8例，右侧11例。年龄58～84岁，平均（71.5±5.8）岁。受伤至手术时间3～18 d，平均（7.9±4.3）d。按Neer分型，三部分骨折伴脱位2例，四部分骨折17例，其中脱位6例，头劈裂2例。19例均采用组合式假体。将大结节骨折碎片复位，测量大结节顶点至肱骨标记点的距离，以此距离作为假体高度的标准。术后1年采用Constant-Murley评分和美国加州大学洛杉矶分校（UCLA）肩关节评分评估肩关节功能状态及患者满意度。
19例患者随访12～58个月，平均（31.9±14.2）个月。术后上臂长度26～32 cm，双侧对比误差<0.5 cm。术后3个月肩关节正侧位X线片显示骨折碎片均愈合。随访1年时，Constant-Murley评分为80.8±8.9，UCLA评分为27.9±4.8。患者满意率为89.5%（17/19）。
以肱骨大结节顶点至肱骨标记点的距离为假体高度标准的大结节骨折碎片复位技术，是治疗肱骨近端骨折半肩关节置换术中简单有效的方法，疗效良好。
