OBJECTIVE: To investigate the factors affecting shoulder joint functions following artificial humeral head replacement. METHODS: A total of 22 patients with complex fracture of proximal humerus, managed by humeral head replacement in Changhai Hospital of The Second Military Medical University from June 2006 to December 2008 were collected, including 12 males and 10 females, with average age of 67 years (52-86 years). During the procedure, soft tissue damage was minimized, the bone of the tuberosity was reserved as much as possible, appropriate matching size of humerus head prosthesis was selected, and early staging functional rehabilitation was performed. Neer's scoring system was used to evaluate the treatment results after replacement. RESULTS: The 22 patients were followed up for 10-30 months, mean 22.6 months. The shoulder joint functions of 14 cases were recovered more quickly through early post-operative staging rehabilitation, No shoulder joint unstable and stiff occurred. The shoulder joint functions of 8 cases were recovered slowly as they complained pain and did not perform early physical therapy after surgery, shoulder joint of 2 cases presented little unstable and 1 case presented stiff. Only 4 cases of all complained occasionally slight shoulder pain, but could continue daily work. The mean movement ranges of shoulder were as follow: mean flexion for 96°(80°-103°), mean extension for 38° (32°-45°), mean abduction for 86°(80°-110°), mean adduction for 31°(30°-35°), mean external rotation for 32°(30°-37°) and internal rotation for 42° (10°-75°). No vasculardamage, nerve damage, lessening prosthesis or prosthesis dislocation was found in all cases. Based on Neer's scoring system, 5 cases were rated as excellent, 11 as good and 4 as fair, with excellent rate of 82% and case satisfaction rate of 87%. CONCLUSION: In order to recover maximally the shoulder joint functions for post-artificial humeral head replacement, we must try our best to avoid soft tissue damage, reserve the bone of the tuberosity, select appropriate humerus head prosthesis, perform early post-operative staging rehabilitation, as well as maintain a normal retroversion of the prosthesis.

Background and purpose: Cervical conization is a common operation to treat precancerous tissues performed under non-intubated anesthesia. As common opioid analgesics have side effects of inhibiting respiration and circulation, other kinds of analgesic drugs should be coordinated to improve the anesthetic effect, without interfering the respiration and circulation. This study aimed to evaluate the effects of dezocine or flurbiprofen combined with propofolremifentanil in cervical precancerosis conization. Methods: Sixty patients who underwent cervical conization were equally randomized into dezocine group (group D), flurbiprofen group (group F) and 0.9％ natural saline (group N) with 20 patients in each group, and received dezocine 0.1 mg/kg, flurbiprofen 1 mg/kg or 0.9％ natural saline in 5 mL respectively before anesthesia induction. During the anesthesia induction, the targeted control infusion of remifentanil in effect concentration was set at 1.5 ng/mL, and the plasma concentration of propofol was set at 2 μg/mL. Heart rate (HR), respiratory rate (RR), surplus pulse O2 (SPO2) and mean arterial pressure (MAP), MAP were monitored before the anesthesia induction (T0) and after (T1), at the start of cervical conization (T2), and at the end of operation (T3). The incidence of respiratory depression and body movements during surgery were observed. The satisfaction degree of the surgeon to the opening status of cervix was evaluated. The post-operative recovery time, visual analogue scale (VAS) scores, nausea and vomiting in the following 12 hours were also recorded. Results: The HR, RR, SPO2 and MAP in three groups did not have any significant change (P＞0.05) at T0, T1 and T3. At T2 the HR and MAP decreased significantly in group D and group F compared with group N (P＜0.05), and there was no significant difference between group D and group F (P＞0.05). The surgical satisfaction degree of "Good" in group D was 80％, significantly higher than that in group N (30％) and group F (50％), indicating a better cervix opening in group D. The recovery time in three groups had no significant difference, and the VAS scores in group D and group F were lower than those in group N (P＜0.05) after operation, and patients did not have nausea or vomiting in the following 12 hours. Conclusion: Both the dezocine and flurbiprofen could improve the anesthetic effect in cervical conization and post-operative comfort, with less respiratory or circulation depression. Dezocine showed better improvement than flurbiprofen in cervix opening and the inhibition of stress response and body movements during surgery.