| Proximal humerus comminuted fractures is a kind of common trauma in orthopedics.Since 1950s, great progress has been made in the pathological anatomy, the understanding and classification of healing and the principle of treatment on this kind of trauma. The majority of the cases of slightly-displaced fractures can obtain good effects through conservative treatment or the open reduction internal fixation. But the controversy over the complicated proximal humerus comminuted fractures still exists currently. With the development of the biomechanical research, the constant improvement of the design of the artificial limb, and the maturity of the operation technique, the operation of humeral head replacement has provided an effective means to treat proximal humerus comminuted fractures. It has definite curative effect on alleviating patients'pain, improving the mobility of the shoulder joint and its function. Humeral head replacement for the treatment of complex proximal humeral fractures, Satisfaction with treatment, but to master surgical indications should be strictly, only those serious displaced proximal humerus fractures,can not be reset or hard reset after a fixed, not the early days of functional exercise, especially humeral head blood supply loss or serious damage to the inevitable occurrence of aseptic necrosis of humeral head, and only consider the removal of humeral head, humeral head replacement line.Humeral head replacement for the surgical operation time, the majority of scholars believe that the sooner such fracture surgery patients, after the better, Early surgery is beneficial nodules and musculotendinous reconstruction and healing.Currently, the diameter, thickness, elevation, retroversion and deflection distance of the adjustable artificial limb can be adjusted, which makes it possible to realize the anatomical reconstruction of the proximal humerus and the ideal tension of the soft tissue. Not only the ideal artificial limb but also the techniques of the operator is the key to achieve the success of the humeral head replacement operation during which the techniques of correctly implanting the artificial limb and reestablishing and balancing the soft tissue are of the utmost importance. Many studies have shown that after the proximal humeral articular surface of the extent of dumping a large variation, not only large differences between individuals, but also in the same individual differences between the left and right side is also very strong. Complex proximal humerus fractures, the nodules are mostly inter-groove damage, surgery should be combined with imaging findings, through the placement and positioning to the forearm longitudinal axis line of anatomical landmark to determine the angle of post and reliable, after the general dumping of humeral head 30°～40°, it should be noted that the purpose is to obtain a stable joint and not a special number. The majority of scholars believe that the prosthetic humeral head height is ideal prosthesis macronodular slightly higher than the rotator cuff, the general 2 to 3 mm, is too partial humeral head may result in nodular or inward too close acromial joint impact the edge of the glenoid, humeral head position would lead to high impact and rotator cuff dysfunction, too partial humeral head after the former partial humeral neck may make the same impact and lead to the edge of the glenoid articular subscapularis muscle and tendon after rotator cuff hypertonicity. Shoulder rotator cuff to maintain stability and outreach on the move function plays an important role in the effectiveness of the reconstruction of the rotator cuff is to ensure that the key to the restoration of shoulder function, some scholars believe that the quality of rotator cuff reconstruction surgery is the failure of poor The primary reason. Rotator cuff surgery in the reconstruction of anatomical reduction must be as much as possible, a solid reconstruction of large and small nodules, so that coverage humeral tubercle, and good healing. For more proximal humeral bone defect, bone graft must be to ensure that large and small healing, top of the humeral bone defect more may consider installing custom prosthesis.The thesis paper is designed to probe into the techniques of the artificial humeral head replacement operation, such as correct implantation and the treatment of rotator cuff and the defects of bone. It also aims at discussing the clinical effect of the operation.Objective To study the clinical effect of humeral head replacement in treating proximal humerus comminuted fractures and its surgical techniques, such as the correct implantation, the reestablishment and balancing of the soft tissue and the treatment of the bone defects.Methods The effects of 26 cases of humeral head replacement in treating proximal humerus comminuted fractures were analyzed retrospectively. The patients in the 26 cases were hospitalized and treated from June 2004 to August 2006.11 are male and 15 are female, aged 36 to 77 and their average age is 58.8. The following-up data of all the cases are complete. According to the classification of Neer:8 fractures are of III type and 18 fractures are of IV type. Thompson approach was adopted in all the cases.Results All the cases were followed-up, from 11 to 36 months. According to the standard of Neer:Excellent in 11 cases, satisfied in 13 cases, unsatisfied in 2 cases, and no failure.Conclusion The malpractice in the treatment of proximal humerus comminuted fractures may lead to complications, such as the stiffness of shoulder joints, nonunion, or malunion. The soft tissues and vessels may be destroyed during the open reduction internal fixation and thus the risk of humeral head necrosis and bone nonunion will be increased. On the premises that the operational indications are fully grasped, the operation of humeral head replacement can alleviate or eliminate patients'pain, help restore the function and stability of the shoulder joint. Consequently, humeral head replacement is an effective way in treating proximal humerus comminuted fractures.
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