Orthopaedics and Traumatology Department, Laon Central Hospital, 33, rue M.-Berthelot, 02001 Laon cedex, France.
Orthop Traumatol Surg Res. 2009 Sep;95(5):325-9. doi: 10.1016/j.otsr.2009.03.018. Epub 2009 Jul 16.
Acute complex proximal humerus fractures in the elderly population, treated by internal fixation or hemiarthroplasty, give well reported radiological results. We investigated the radiological outcome of the reverse arthroplasty concept in this indication.
From 1993 to 2007, 41 Delta III prostheses were implanted following 32 three-part and four-part displaced fractures, and in nine fracture/dislocations; three fractured patients were males and 38 females; mean age at fracture time was 75 years. The results were evaluated on AP and Lamy lateral shoulder views.
Since nine of these patients were deceased and two had moved, 30 cases were available at review, with a mean follow-up of 6.5 years (range, 1-14). The radiographs showed two thick radiolucent lines on the glenoid component with one aseptic loosening of the base plate at 12 years. Based on the Nérot classification, 17 cases of inferior scapular notching were, in total, observed. The mean time to onset was 2 years for the seven grade 1 notches (41%), 4 years for the five grade 2 notches (30%), 5 years for the three grade 3 notches (17%) and 6 years for the two grade 4 notches (12%). Fourteen inferior spurs (stable after emergence) were reported with a mean time to onset of 2.5 years (range, 1-6 years). One joint ossification occurred at 6 months and was stable at the 6-year follow-up review. The humeral component results comprised four cases of medial (5, 6, 7 and 10 years) proximal bone loss and two cases of bone-cement interface deterioration (medial radiolucent lines at two-third of the stem height at the 5-year follow-up). In these six cases, a notch was present above this area. In addition, one case of humeral septic loosening is reported at 2-year follow-up.
For acute proximal humeral complex fractures in the elderly population, when refixation of the tuberosities on a classical orthopaedic devices appears compromised, the use of a Delta III reverse prosthesis is an attractive alternative; however, with a mean follow-up of 6.5 years, this prosthesis demonstrates unsatisfactory images in 70% of the cases. These flaws were noted on the glenoid component in 70% of the cases, appeared before 7 years in 86% and were progressive in 50% of the cases. However, only one revision was required for an aseptic loosening of the base plate at 12 years. New developments in designs and bearing surfaces and larger numbers analysis of long-term results will probably be needed to encourage extensive utilization of the reverse concept in this fracture indication.
Level IV. Therapeutic retrospective study.
对于老年人群中的急性复杂肱骨近端骨折，采用内固定或半髋关节置换术治疗可获得良好的影像学结果。本研究旨在探讨反向关节置换术在该适应证中的影像学结果。
1993 年至 2007 年，我们对 32 例三部分和四部分移位骨折以及 9 例骨折脱位患者采用 Delta III 假体进行了治疗，其中 3 例为男性，38 例为女性；骨折时的平均年龄为 75 岁。我们对肩峰的前后位和 Lamy 侧位片进行了评估。
由于其中 9 例患者死亡，2 例患者搬家，因此在复查时，30 例患者可进行评估，平均随访 6.5 年（范围，1-14 年）。X 线片显示，2 例患者的肩峰假体有 2 条明显的骨溶解线，其中 1 例在 12 年时出现基底部假体无菌性松动。根据 Nérot 分类，共观察到 17 例肩胛盂下切迹。7 例 1 级切迹（41%）的起始时间平均为 2 年，5 例 2 级切迹（30%）为 4 年，3 例 3 级切迹（17%）为 5 年，2 例 4 级切迹（12%）为 6 年。报告了 14 例下骨赘（出现后稳定），起始时间的平均时间为 2.5 年（范围，1-6 年）。1 例在 6 个月时出现关节骨化，在 6 年的随访中保持稳定。肱骨假体的结果包括 4 例（5、6、7 和 10 年）内侧近端骨丢失和 2 例骨水泥界面恶化（在 5 年随访时，假体柄的 2/3 高度处出现内侧透亮线）。在这 6 例中，该区域上方存在切迹。此外，在 2 年的随访中报告了 1 例肱骨头感染性松动。
对于老年人群中的急性复杂肱骨近端骨折，当经典骨科装置固定结节变得困难时，使用 Delta III 反式假体是一种有吸引力的选择；然而，在平均 6.5 年的随访中，这种假体在 70%的病例中显示出不理想的图像。这些缺陷在 70%的病例中出现在肩峰假体上，在 86%的病例中出现在 7 年内，在 50%的病例中呈进行性发展。然而，只有 1 例因基底部假体无菌性松动在 12 年时需要翻修。需要对设计和轴承表面进行新的发展，并对长期结果进行更大数量的分析，以便鼓励在这种骨折适应证中广泛应用反向概念。
IV 级。治疗回顾性研究。
