摘要
目的：评价采用分期反肩置换手术治疗肱骨近端骨折术后感染的临床疗效。方法：回顾性研究2013年1月至2014年12月收治并获得随访的8例因肱骨近端骨折术后感染行分期反肩置换手术治疗的患者资料,其中男1例,女7例,平均年龄（58.5±6.4）岁（52-72岁）。8例患者中,2例人工肱骨头置换术后假体周围感染,6例肱骨近端骨折切开复位内固定术后钢板周围感染伴肱骨头坏死,所有患者均于二期手术时翻修为反球型人工肩关节。术后定期随访,采用疼痛视觉模拟评分（visual analogue score,VAS）、Constant评分（Constant score）及加州大学洛杉矶分校评分（University of California Los Angeles,UCLA）评价肩关节功能状况。结果：术后随访时间（19.9±8.0）个月（12-35个月）,末次随访患者的肩关节活动度均较术前有所改善：前屈上举为100°（60°,140°）vs.25°（0°,90°）,P=0.011;体侧外旋为15°（0°,50°）vs.5°（0°,20°）,P=0.048;内旋为第4腰椎体水平（臀部,第12胸椎体）vs.臀部水平（臀部,第3腰椎体）,P=0.041。3项评分也均较术前有所改善：Constant评分为53.5（32,74）vs.29.0（10,57）,P=0.012;UCLA评分为20.5（9,26）vs.9.5（5,15）,P=0.012;VAS疼痛评分为1.5（0,5）vs.5.0（0,8）,P=0.018。结论：采用分期手术方法治疗肱骨近端骨折术后感染对于控制感染复发疗效显著,术后肩关节功能有所改善。
Objective： To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures. Methods： From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were retrospectively reviewed after the final follow-up. There were 1 man and 7 women with a mean age of（ 58. 5 ± 6. 4） years,of whom 3 left shoulders and 5 right shoulders were involved. There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with humeral head necrosis as well as implant-associated infection after open reduction internal fixation for proximal humeral fractures with the locking plate. The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery. At the firststage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate. During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoulder prosthesis was performed in all the patients who were routinely followed up after the second-stage surgery. The visual analogue score（ VAS）,Constant score and University of California Los Angeles（ UCLA） score were employed to evaluate the postoperative shoulder function. Results： The mean followup time was（ 19. 9 ± 8. 0） months（ range 12 to 35 months）. At the end of the follow-up,the median forward elevation [100°（ 60°,140°） vs. 25°（ 0°,90°）,P = 0. 011 ],the median external rotation[15°（ 0°,50°） vs. 5°（ 0°,20°）,P = 0. 048],and the median internal rotation [L4（ buttock,T12）vs. buttock（ buttock,L3）,P = 0. 041] were all significantly improved postoperatively. The median Constant score [53. 5（ 32,74） vs. 29. 0（ 10,57）,P = 0. 012],the median UCLA score [20. 5（ 9,26） vs. 9. 5（ 5,15）,P = 0. 012 ],and the median VAS score [1. 5（ 0,5） vs. 5. 0（ 0,8）,P =0. 018]were all significantly improved after the surgery. No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up. Conclusion： Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures. The shoulder function was postoperatively improved to a certain degree.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2016年第2期263-267,共5页
Journal of Peking University:Health Sciences
基金
首都临床特色应用研究(Z141107002514001)资助~~
关键词
肩关节
关节成形术
置换
假体相关感染
肱骨骨折
分期手术
Shoulder joint
Arthroplasty
replacement
Prosthesis-related infections
Humeral fractures
