Athwal George S, Sperling John W, Rispoli Damian M, Cofield Robert H
Mayo Clinic, Rochester, Minnesota, USA.
J Bone Joint Surg Am. 2009 Mar 1;91(3):594-603. doi: 10.2106/JBJS.H.00439.
Currently, there is little information available on the treatment and outcome of intraoperative periprosthetic humeral fractures that occur during shoulder arthroplasty. The purpose of this study was to report on the incidence, treatment, and outcome of, as well as the risk factors for, intraoperative periprosthetic humeral fractures.
Between 1980 and 2002, forty-five intraoperative periprosthetic humeral fractures occurred during shoulder arthroplasty at our institution. Twenty-eight fractures occurred during primary total shoulder arthroplasty, three occurred during primary hemiarthroplasty, and fourteen occurred during revision arthroplasty. Nineteen fractures involved the greater tuberosity, sixteen involved the humeral shaft, six involved the metaphysis, three involved the greater tuberosity and the humeral shaft, and one involved both the greater and lesser tuberosities. All patients were followed for a minimum of two years. At the time of the latest follow-up, outcomes were assessed, radiographs were examined, and relative risks were calculated.
Over the twenty-two-year study period, the rate of intraoperative humeral fractures at our institution was 1.5%. All fractures healed at a mean of seventeen weeks. In the primary arthroplasty group (thirty-one patients), range of motion and pain scores improved significantly (p < 0.05) at the time of follow-up. In the revision arthroplasty group (fourteen patients), range of motion remained unchanged whereas pain scores improved significantly (p < 0.005). Transient nerve injuries occurred in six patients. Four fractures displaced postoperatively and were then treated nonoperatively; all four healed. Significant relative risks for intraoperative fracture were female sex, revision surgery, and press-fit implants (p < 0.05).
The data from the present study suggest that although intraoperative humeral fractures are associated with a high rate of healing, there was a substantial rate of associated complications, including transient nerve injuries and fracture displacement. Significant risk factors for intraoperative fractures include female sex, revision surgery, and press-fit humeral implants.
目前，关于肩关节置换术中发生的术中假体周围肱骨骨折的治疗及结果的信息较少。本研究的目的是报告术中假体周围肱骨骨折的发生率、治疗方法、结果以及危险因素。
1980年至2002年期间，在我们机构进行的肩关节置换术中发生了45例术中假体周围肱骨骨折。28例骨折发生在初次全肩关节置换术中，3例发生在初次半肩关节置换术中，14例发生在翻修置换术中。19例骨折累及大结节，16例累及肱骨干，6例累及干骺端，3例累及大结节和肱骨干，1例累及大、小结节。所有患者均随访至少两年。在最近一次随访时，评估结果，检查X线片，并计算相对风险。
在22年的研究期间，我们机构术中肱骨骨折的发生率为1.5%。所有骨折平均在17周时愈合。在初次置换组（31例患者），随访时活动范围和疼痛评分显著改善（p<0.05）。在翻修置换组（14例患者），活动范围保持不变，而疼痛评分显著改善（p<0.005）。6例患者发生短暂性神经损伤。4例骨折术后移位，随后接受非手术治疗；均愈合。术中骨折的显著相对危险因素为女性、翻修手术和压配式植入物（p<0.05）。
本研究数据表明，虽然术中肱骨骨折愈合率较高，但相关并发症发生率较高，包括短暂性神经损伤和骨折移位。术中骨折的显著危险因素包括女性、翻修手术和压配式肱骨植入物。
