Karolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Stockholm Söder Hospital, Sweden.
J Shoulder Elbow Surg. 2011 Oct;20(7):1025-33. doi: 10.1016/j.jse.2011.04.016. Epub 2011 Jul 23.
The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative treatment.
We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24 months. The main outcome measures were health-related quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores.
At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the nonoperative group, EQ-5D (index) score 0.81 compared to 0.65 (P = .02). The results for DASH and pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P = .25) and pain according to VAS 15 versus 25 (P = .17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95° and a mean abduction of 85-90°. The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group.
The results of the study demonstrated a significant advantage in quality of life in favor of HA, as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM.
本研究旨在报告对老年移位性肱骨近端四部分骨折患者行人工半肩关节置换术（HA）或非手术治疗的 2 年随访结果。
共纳入 55 例患者，平均年龄 77 岁（58-92 岁），86%为女性。4 个月、12 个月和 24 个月时进行随访检查。主要观察指标为 EQ-5D 和 DASH、Constant 评分的健康相关生活质量（HRQoL）。
最终 2 年随访时，HA 组患者的 HRQoL 显著优于非手术组，EQ-5D（指数）评分 0.81 优于 0.65（P=0.02）。DASH 和疼痛评估结果均有利于 HA 组，DASH 评分 30 优于 37（P=0.25），VAS 疼痛评分 15 优于 25（P=0.17）。Constant 评分和关节活动度（ROM）无显著差异。两组患者平均屈曲度均约为 90-95°，平均外展度为 85-90°。需要进一步手术的患者较少：HA 组 3 例，非手术组 1 例。
与非手术治疗相比，该研究结果表明，人工半肩关节置换术可显著提高老年移位性肱骨近端四部分骨折患者的生活质量，其主要优势在于减轻疼痛，而在 ROM 方面无差异。
