Shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures

Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total of 55 patients who suffered from com-plex proximal humeral fractures were treated by shoulder hemiarthroplasty. The mean age was 55.6 years and mean follow-up period was 25.1 months. The scoring system modi-fication for hemiarthroplasty (SSMH) had been adopted for evaluation at the latest follow-up.Results: The pain was obviously relieved in all patients. Fifty patients were painless and 5 patients had slight pain. The mean range of motion was 100°(90°-110°) in abduction, 95°(80°-100°) in forward flexion, 35°(30°-40°) in extemal rotation and internal rotation was confined at L2 level (L1-L3). The mean SSMH score was 27.9 (24-29). Fifty patients (90.1%) were satisfied with the clinical outcome.Conclusions: Shoulder hemiarthroplasty is an effective method to treat complex proximal humeral fractures. The proper selection of patients and prosthesis, good operation skill and enough functional exercise are the key points of successful treatment.     

Four-part displaced proximal humeral fractures: treatment with hemiarthroplasty

Between 1996 and 2000 a total of 25 hemiarthroplasties of the shoulder in just as many patients were carried out. A total of 15 were followed-up (minimum 1 year, maximum 5 years, mean 2.5 years; mean age 75.5 years). The Constant score showed a mean of 73.26 points (with a maximum score of 90 and a minimum of 40). One patient obtained a reduced Constant score (40 points) because of severe lesions of the rotator cuff and continuous pain, even during the night. Patients reported that they were satisfied in 75% of cases. We believe that the integrity of the cuff is an essential condition for final success, alongside important indications such as type of fracture, bone quality, age and motivations of the patient, with respect for rules governing method of implantation and protocols for rehabilitation used.     

人工肱骨头置换治疗肱骨近端三、四部分骨折

目的探讨人工肱骨头置换治疗肱骨近端骨折,术中应注意的关键问题. 方法采用Thompson入路行人工肱骨头置换术23例. 术后随访6～36个月,平均随访21.1个月.用ASES评分对患肩进行术后功能评估.结果医师客观评定:全部患者肩关节活动明显改善,肌力恢复良好,肩关节稳定,5例轻压痛,1例发生撞击.患者主观评定:疼痛平均102分,肩关节稳定平均106分,完成10个日常生活动作22例,完成7个日常生活动作1例.复查X线片显示人工肱骨头位置良好,无假体松动,肱骨大、小结节骨折愈合. 结论术中肩周软组织保护及修复,人工肱骨头假体安装和肱骨大、小结节解剖重建是提高人工肱骨头置换术疗效的关键技术.     

Functional outcome after proximal humeral fractures treated with hemiarthroplasty

Objective

To evaluate functional outcome after hemiarthroplasty for displaced proximal humeral fractures and to review whether prosthesis type, intraoperative technique or previous ipsilateral shoulder surgery could affect the outcome.

Methods

We reviewed the medical records and radiographs of patients who had undergone hemiarthroplasty for proximal humeral fractures between 1992 and 2000. We identified 45 patients, 39 with acute fractures and 6 with fracture-related complications. One surgeon performed 17 surgeries (38%), and the rest were carried out by 11 other orthopedic surgeons. Using the American Shoulder and Elbow Surgeons Evaluation Form and the Western Ontario Rotator Cuff Index, we evaluated patients who had been followed for at least 2 years for residual shoulder pain, range of motion, strength, stability and function. The senior authors reviewed the radiographs.

Results

The mean age of the patients at presentation was 70 (range 46–95) years. The mean active forward elevation was 87°, abduction 63° and external rotation 22°; the mean internal rotation was to the L2 vertebra. Of the patients, 15% reported severe pain, and 25% were unable to sleep on the affected side. Patients with previous surgeries and those with intraoperative cuff tears were found to have more postoperative pain.

Conclusion

We conclude that soft tissue status and operative technique play an important role in late postoperative pain and range of motion. Hemiarthroplasty after failed open reduction and internal fixation is associated with inferior results. We were unable to show a difference in long-term outcome related to the prosthesis type.     

半肩置换治疗严重肱骨近端骨折的临床结果分析

目的评价半肩置换治疗严重肱骨近端骨折的临床疗效,并对影响治疗结果的因素进行分析。方法2001年7月至2005年5月共收治42例患者,平均年龄63岁,术后随访时间12～48个月,平均29个月。对所有患者进行主观评价,同时对活动度、肌力、稳定性、活动顺滑度进行评估。随访时拍摄肩关节X线片,27例患者拍摄术后双侧肱骨全长位片;15例患者行术后肩关节CT检查。结果根据Constant-Murley评分19例患者非常满意（45％）,17例满意（40％）,6例不满意（15％）,总满意率达到85％。术后主动前屈（100±32）°,外旋（16±11）°,内旋后伸达L2水平。结论采用人工肱骨头置换术治疗严重的肱骨近端骨折可取得良好手术效果,但需要严格掌握手术适应证。术中肱骨长度恢复不佳、假体后倾角度过大、大小结节固定不确切、愈合不良、大结节吸收及异位骨化等是造成效果不满意的原因。     

内固定与肱骨头置换治疗高龄肱骨近端骨折比较

[目的]比较切开复位解剖锁定钢板内固定术(locking proximal humeral plate,LPHP)与肱骨头置换(humeral hemiar-throplasty,HHA)治疗高龄患者复杂肱骨近端骨折的临床疗效.[方法]回顾性分析2015年1月-2018年1月,手术治疗78例高龄(≥80岁)复杂肱骨近端...     

肱骨近端骨折肩关节置换术假体高度确定的解剖学研究

目的 探讨肱骨近端骨折肩关节置换术中确定假体植入高度的方法.方法 选择成人尸体标本11具,男7具,女4具,共22个肩关节.测量胸大肌肱骨止点上缘至肱骨头关节面顶点的距离(PMT)、大结节高度(HT)及肱骨长度(HL),计算PMT/HL. 结果 所有标本PMT平均为(5.10±0.54)cm,HT平均为(0.78±0.19)cm,HL平均为(28.9±1.9)cm,PMT/HL的平均值为17.6%.所有标本HL的测量结果均乘以17.6%,分别与其PMT的测量结果比较偏差不超过0.5 cm.PMT、HT、HL左侧和右侧的测量结果差异均无统计学意义(P＞0.05).PMT和HL的测量结果呈正相关,HT和HL的测量结果无明显相关性. 结论 胸大肌腱止点上缘可作为肱骨近端骨折肩关节置换术中确定假体植入高度的可靠参照.术中可以根据国人PMT的平均值5.10 cm或个体化的数值,即将测量的术前健侧HL乘以固定的系数17.6%来推测患侧PMT,从而决定假体顶点至胸大肌腱肱骨止点上缘的距离.     

单纯人工肱骨头置换术治疗肱骨近端粉碎性骨折

目的探讨单纯人工肱骨头置换术治疗肱骨近端严重3～4部分骨折的方法及其效果。方法对本组12例肱骨近端粉碎性骨折患者进行了单纯人工肱骨头置换术,其中男5例,女7例,年龄42～67岁,平均（54．3±3．4）岁。按AO骨折分类标准,9例B2型骨折,2例B3型骨折,1例c3型骨折。结果术后随访9～36个月,平均17．2个月。采用Neer标准评定患者肩关节功能,其中4例大于90分,其余均在80分以上。结论对于肱骨近端粉碎性骨折而言,单纯人工肱骨头置换术是一种疗效较好的治疗方法,人工肱骨头假体安装和肱骨大、小结节解剖重建是提高人工肱骨头置换术疗效的关键,并且术中注意修复损伤的肩袖。术后需要求患者积极进行康复训练促进功能恢复。     

Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures

Background

There remains no consensus on the surgical treatment of complex proximal humeral fractures. In this meta-analysis, we pool available trials to compare the clinical outcomes of locking plate fixation and hemiarthroplasty for this injury.

Methods

A literature search between January 1990 and May 2012 in the main medical search engines (Pubmed, Medline, Embase search, and the Cochrane library) was included. We selected available trials that compared locking plate fixation and hemiarthroplasty in patients with complex proximal humeral fractures and that reported on functional outcomes, revisions, and method-related complications. The quality of the studies was assessed, and meta-analyses were performed with the Cochrane Collaboration’s REVMAN 5.0 software.

Results

A total of 567 patients from 9 trials were included in this meta-analysis (302 fractures treated with locking plate and 265 with hemiarthroplasty). In this comparison, we found that patients with locking plate fixation had better Constant–Murley score than with hemiarthroplasty, and hemiarthroplasty could reduce the rate of revisions and the method-related complications significantly.

Conclusions

Compared with hemiarthroplasty, patients with locking plate fixation could obtain more favorable functional outcomes, but technical detail was critical to minimize the risk of implant failure, avascular necrosis, and re-operation. As the possible significant bias and inconclusive evidence arising from the included trials, further randomized trials and observational studies should be recommended to support these finding.     

Reconstruction of humeral length and centering of the prosthetic head in hemiarthroplasty for proximal humeral fractures

Anatomic reconstruction of humeral length in hemiarthroplasty for complex proximal humeral fractures is difficult because reliable surgical landmarks are missing or are destroyed by the fracture. The pectoralis major tendon is a reliable landmark to determine prosthetic height intraoperatively. This study analyzed the clinical outcome, reconstruction of humeral length, centering of the prosthetic head in the glenoid, and tuberosity positioning and healing, using the pectoralis major tendon as a reference intraoperatively. The study included 30 patients. In 21 patients (group 1), humeral length reconstruction was performed using the pectoralis major tendon as a reference; in 9 (group 2), this reference was not used. Patients underwent a clinical and radiologic evaluation at a mean of 22.7 months. Group 1 showed significantly better results in clinical and radiologic values, especially in anatomic reconstruction of humeral length, than group 2. Clinical outcome depended significantly on greater tuberosity healing and centering of the prosthetic head in the glenoid.     

肱骨近端骨折的手术治疗

目的 探讨肱骨近端骨折的外科治疗。方法 48例肱骨近端骨折，其中保守治疗失败的NeerⅡ型骨折8例、NeerⅢ型骨折26例、NeerⅣ型骨折14例，均采用手术治疗，分别行开放复位、肱骨近端解剖型钢板内固定(38例)和肱骨头假体置换术(10例)。术后按美国肩肘关节医师学会肩关节评分系统进行疗效评价。结果 所有病例均获随访，时间为9～24个月。患肩无明显疼痛，患肩关节上举、内旋、外旋，完成五项日常生活能力，总体恢复满意。结论 对保守治疗失败的NeerⅡ型骨折、NeerⅢ、Ⅳ型骨折应采取手术治疗，而NeerIV型骨折以假体置换术为佳。     

肱骨近端骨折的手术治疗

目的探讨肱骨近端骨折手术治疗效果。方法手术治疗移位的肱骨近端骨折52例,行开放复位、肱骨近端解剖型钢板或三叶草型钢板内固定45例,肱骨头假体置换术7例。结果所有病例获随访6-24个月,优34例,良11例,可6例,差1例。结论肱骨近端移位骨折采用手术治疗可取得满意的效果。对NeerⅣ型骨折以假体置换术为佳。     

Early management of proximal humeral fractures with hemiarthroplasty: a systematic review

We performed a comprehensive systematic review of the literature to examine the role of hemiarthroplasty in the early management of fractures of the proximal humerus. In all, 16 studies dealing with 810 hemiarthroplasties in 808 patients with a mean age of 67.7 years (22 to 91) and a mean follow-up of 3.7 years (0.66 to 14) met the inclusion criteria. Most of the fractures were four-part fractures or fracture-dislocations. Several types of prosthesis were used. Early passive movement on the day after surgery and active movement after union of the tuberosities at about six weeks was described in most cases. The mean active anterior elevation was to 105.7 degrees (10 degrees to 180 degrees) and the mean abduction to 92.4 degrees (15 degrees to 170 degrees). The incidence of superficial and deep infection was 1.55% and 0.64%, respectively. Complications related to the fixation and healing of the tuberosities were observed in 86 of 771 cases (11.15%). The estimated incidence of heterotopic ossification was 8.8% and that of proximal migration of the humeral head 6.8%. The mean Constant score was 56.63 (11 to 98). At the final follow-up, no pain or only mild pain was experienced by most patients, but marked limitation of function persisted.     

肱骨近端内锁定系统钢板治疗肱骨近端骨折的初步报告

肱骨近端骨折约占全身骨折的5%,通常骨折粉碎,移位明显且多合并其他损伤,其治疗目标为重建功能正常且无痛的肩关节.