中华肩肘外科电子杂志
中華肩肘外科電子雜誌
중화견주외과전자잡지
Chinese Journal of Shoulder and Elbow (Electronic Edition)
2014年
3期
174-177
,共4页
吕泽斌%胡晓梅%林砚铭%董万涛%尉伟卫%李磊
呂澤斌%鬍曉梅%林硯銘%董萬濤%尉偉衛%李磊
려택빈%호효매%림연명%동만도%위위위%리뢰
肱骨骨折,近端%肩关节%肱骨头置换术,人工%康复
肱骨骨摺,近耑%肩關節%肱骨頭置換術,人工%康複
굉골골절,근단%견관절%굉골두치환술,인공%강복
Humerus fractures,proximal%Shoulder joint%Humeral head replacement%Rehabilitation
目的：探讨人工肱骨头置换术后早期康复训练对肩关节功能恢复的效果。方法自2010年2月至2013年6月，对11例严重肩关节损伤患者行人工肱骨头置换术。男性3例，女性8例；年龄46~73岁，平均52.1岁。致伤原因：肱骨近端骨折9例，肱骨头缺血性坏死1例，肱骨近端骨巨细胞瘤1例。手术由同组医师完成，术后早期开始康复训练，采用改良 UCLA 评分表评定治疗效果。结果1例患者于术后6个月死于肿瘤全身转移，其余10例平均随访15.4个月(12~40个月)。改良 UCLA 评分：优8例，良2例，差0例。结论早期进行康复训练维持重建关节的活动度，促进肌力恢复，改善关节功能，在人工肱骨头置换术远期疗效中发挥关键作用。
目的：探討人工肱骨頭置換術後早期康複訓練對肩關節功能恢複的效果。方法自2010年2月至2013年6月，對11例嚴重肩關節損傷患者行人工肱骨頭置換術。男性3例，女性8例；年齡46~73歲，平均52.1歲。緻傷原因：肱骨近耑骨摺9例，肱骨頭缺血性壞死1例，肱骨近耑骨巨細胞瘤1例。手術由同組醫師完成，術後早期開始康複訓練，採用改良 UCLA 評分錶評定治療效果。結果1例患者于術後6箇月死于腫瘤全身轉移，其餘10例平均隨訪15.4箇月(12~40箇月)。改良 UCLA 評分：優8例，良2例，差0例。結論早期進行康複訓練維持重建關節的活動度，促進肌力恢複，改善關節功能，在人工肱骨頭置換術遠期療效中髮揮關鍵作用。
목적：탐토인공굉골두치환술후조기강복훈련대견관절공능회복적효과。방법자2010년2월지2013년6월，대11례엄중견관절손상환자행인공굉골두치환술。남성3례，녀성8례；년령46~73세，평균52.1세。치상원인：굉골근단골절9례，굉골두결혈성배사1례，굉골근단골거세포류1례。수술유동조의사완성，술후조기개시강복훈련，채용개량 UCLA 평분표평정치료효과。결과1례환자우술후6개월사우종류전신전이，기여10례평균수방15.4개월(12~40개월)。개량 UCLA 평분：우8례，량2례，차0례。결론조기진행강복훈련유지중건관절적활동도，촉진기력회복，개선관절공능，재인공굉골두치환술원기료효중발휘관건작용。
Background As the artificial joint technology and material become matured gradually,the humeral head replacement starts to play an important role in the clinical treatment of severe lesion of shoulder joint,which can effectively relieve pain and recover the passive range of motion of the shoulder joint after operation,but its active motion still depends on the shoulder muscle strength,so the early postoperative rehabilitation training has become the key treatment measures after the humeral head replacement.This paper discusses the effect of early rehabilitation training on the shoulder joint recovery after artificial humeral head replacement.Methods From February 2010 to June 2013,1 1 cases of severe shoulder joint lesion received the artificial humeral head replacement operation.Among them,3 were males,8 were females;aged 46 to 73 years old,averagely 52.1 years old.The cause of injury:9 cases of proximal humeral fractures,1 case of ischemic necrosis of the humeral head and 1 case of giant cell tumor of proximal humerus.With the contralateral shoulder as control,preoperative routine anteroposterior,oblique and axillary plain X-ray of shoulder joint were required,and also the shoulder MRI examination,in order to assess the damage of skeletal and soft tissue.Use the beach chair position under general anesthesia.Then routinely do the skin preparation and draping.We take the deltoid and pectoralis major muscle interval approach,then release the deltoid along the shaft of humerus,and retract the conjoint tendon medially,incise the subscapularis tendon and the anterior capsule,adjust the hypsokinesis angle according to the joint stability,cut off it and measure the diameter of humeral head to determine the size of prosthesis,carefully clean the broken ends of the proximal humerus fracture patients.Install the suitable size of test model after largening the medullary cavity,check the ROM and soft tissue tension after the reduction of the shoulder.Remove the template if it is ideal,pulse flushing the medullary cavity,use the bone cement to stabilize the prosthesis,reset the shoulder joint,use the Ethibond suture to fix the subscapularis and tubercules,carefully repair of the rotator cuff,at last make sure the shoulder joint function is good without impingement.Rinse the wound again and place a plasma drainage,finally close the incision layer by layer.Keep the drainage according to the amount of blood in 24-48 h,protect the limb with a wrist neck sling for 3-6 weeks.The rehabilitation training started the first day after the operation,operated by specialized rehabilitation physicians in different stages.Passive activities are in the main position during the early stage,then gradually transit to the active and strength training.The first stage:do the hand,wrist,elbow flexion and extension training,passive shoulder flexion and lateral external rotation exercise 1 to 2 weeks postoperatively.According to the individual tolerance, gradually increase the amount of activity.The second stage:the shoulder swelling is gone and the pain is relieved,also the surgical suture is removed after 3-6 weeks,patients were instructed to gradually strengthen the shoulder internal rotation,muscle isometric and active anti resistance training in the clinic.The third stage:the tendon has healed and the activity of shoulder joint has improved after 7-12 weeks,mainly do the active muscle strength exercise to increase the range of motion.The fourth stage:12 weeks later,on the basis of former training,further strengthen the strength resistance training,and selectively focus on some muscle and joint assess the patient′s houlder function before operation and 6 and 12 weeks post operatively.The modified UCLA score is taken in evaluation of pain relief,joint function,range of motion and muscle recovery.In 35 total points:34-35 is excellent, 29-33 is good;29 or less is poor.Results 1 patient died of tumor metastasis 6 months after operation, the other 10 cases were followed up for averagely 1 5.4 months (12-40 months).The incision of all the patients were healed without infection,2 cases complained the shoulder pain,which was relieved by symptomatic treatment.All the 1 1 patients got X-ray examinations the first day after operation, before leaving the hospital,after 6 and 12 months.It showed a good position of prosthesis and there was no sign of loosening, joint instability, shoulder impingement, joint stiffness and other complications.The patients were satisfied with their shoulder joint function.After 6 weeks,the active ROM of shoulder improved significantly,compared with it before the surgery,the difference was statistically significant (t =7.32,P <0.05);the shoulder AROM further recovered after 12 weeks, then they can look after themselves,the difference was statistically significant in each direction′s activity,compared with 6 weeks after operation (t = 5.56,P < 0.05 ).The difference of shoulder direction was statistically significant,compared with the healthy side (t =2.05,P <0.05).We use a modified UCLA score to evaluate the shoulder function :excellent in 8 cases,good in 2 cases,poor in 0 cases,the average score was 33.6.For the data processing,we use SPASS 1 7.0 software to deal with the statistics,all the data are expressed by (s)before and after treatment,using one sample t test,P <0.05 means the difference was statistically significant.Conclusions The early rehabilitation training activities is good to maintain the ROM of the reconstructed joint,promote the recovery of muscle strength and improve the function of joint.It plays a key role in the long-term effect of humeral head replacement.
