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目的：探讨人工肱骨头置换治疗老年粉碎性骨折的适应证，术中注意及早期疗效。方法对20例肱骨近端四部分骨折的老年患者采用人工肱骨头置换术进行回顾性分析。结果20例均获随访，时间6~20个月，按Neer肩关节功能评分，优：6例，满意：12例，不满意：2例。结论在合理选择手术适应证条件下，精密的手术操作，重点重建肩袖和关节稳定结构，术后长期完善的的功能锻炼，人工肱骨头置换术治疗老年肱骨近端粉碎性骨折可取得较好疗效。“,”Objective To explore the shoulder hemiarthroplasty in the treatment of comminuted proximal humeral fractures in elderly patients and its indication, surgical at ention and early clinical ef icacy Methods 20 patients with four-part fractures with head replacement had been reviewed Results The patients were fol owed up for 6-20 months, According to Neer evaluation system, the results were excel ent in 6 cases ,good in 12 and poor in 2,the fine rate was 90%. Conclusion With cor ect indication and meticulous surgical techniques, pay at ention to reconstruction of rotating cuf and stable structure of the joint, long rational rehabilitation exercise. The humeral head replacement is an ef ective method for treating complex proximal humeral fractures in elderly patients.