上腕骨近位部粉砕骨折に対する人工骨頭置換術の治療成績

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In this study, we analyzed the clinical outcome and radiological evaluation in cases with proximal humeral fracture or fracture-dislocation of the shoulder treated by hemiarthroplasty. Eighteen cases with an acute displaced proximal humeral fracture and five cases with an acute fracture-dislocation were the subjects of this study. There were twenty-two women and one man whose mean age was 75.4 years old (64 to 92 years old). Global shoulder hemiarthroplasty was applied in 14 cases, the Biomodular-type in 7 cases and the Neer-type in 2 cases. The average follow-up period was 5.8 years (1.2 to 14 years). The postoperative results were evaluated according to the Japanese Orthopaedic Association shoulder score (JOA score). Parameters for radiological evaluation were values of AHI, humeral offset, medial and lateral projections, and the existence of a spur beneath the acromion, a radiolucent zone of the humeral shaft and an osteolytic change of the greater tuberosity. The average postoperative JOA score was 83.7 points (64 to 97 points). The mean values of AHI and humeral offset were 9.0mm and 28.4mm, respectively. A spur beneath the acromion was observed in five cases, and a radiolucent zone at the humeral shaft in three cases. There was a significant correlation between the postoperative JOA score and values of AHI or humeral offset. The average JOA score in the cases with a spur beneath the acromion or a radiolucent zone of the humeral shaft was markedly lower than that in cases without them. This study suggests that results of hemiarthroplasty be influenced by factors reflecting functions and conditions of the rotator cuff. We conclude that anatomical reconstruction of the greater tuberosity and the rotator cuff is important to obtain satisfactory results in hemiarthroplasty.
日本肩関節学会の論文

上腕骨近位部粉砕骨折に対する人工骨頭置換術の治療成績

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