The Case Shoulder & Elbow Service, Department of Orthopaedic Surgery, University Hospitals of Cleveland, 11100 Euclid Avenue, HH5043, Cleveland, OH 44106, USA.
Clin Orthop Relat Res. 2011 Dec;469(12):3324-31. doi: 10.1007/s11999-011-2055-z.
The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function.
QUESTIONS/PURPOSES: We (1) evaluated ROM, pain level, and American Shoulder and Elbow Surgeons scores of patients who had a reverse total shoulder arthroplasty for displaced three- and four-part proximal humerus fracture and (2) identified clinical and radiographic complications from the procedure.
We retrospectively reviewed 30 patients in three institutions who had undergone a primary reverse total shoulder arthroplasty for displaced three- or four-part proximal humerus fractures. Mean age was 77 years (range, 65-94 years). Minimum followup was 12 months (mean, 23 months; range, 12-36 months).
Mean postoperative American Shoulder and Elbow Surgeons score was 78 (range, 36-98), mean active forward flexion was 139° (range, 90°-180°), and mean active external rotation was 27° (range, 0°-45°). Mean American Shoulder and Elbow Surgeons pain score was 0.7 (range, 0-5) and mean visual analog scale pain score was 1.1 (range, 0-5). Complications were identified in three of 30 patients (10%).
At short term, reverse total shoulder arthroplasty relieved pain and improved function. The complication rate compared favorably with those reported for other treatment alternatives.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
治疗老年患者粉碎性肱骨近端骨折具有挑战性。传统技术（包括切开复位内固定、经皮钢针固定和人工半肩关节置换术）的功能结果评分、ROM、患者满意度和骨愈合情况存在不同的数值。另一种选择是反式全肩关节置换术，但尚不清楚它是否能提供更好的 ROM 或功能。
问题/目的：我们（1）评估了 30 例因移位的三部分和四部分肱骨近端骨折而行反式全肩关节置换术的患者的 ROM、疼痛程度和美国肩肘外科评分，以及（2）确定了该手术的临床和影像学并发症。
我们回顾性分析了 3 家机构的 30 例因移位的三部分或四部分肱骨近端骨折而行初次反式全肩关节置换术的患者。平均年龄为 77 岁（范围，65-94 岁）。最低随访时间为 12 个月（平均 23 个月；范围，12-36 个月）。
术后平均美国肩肘外科评分 78 分（范围，36-98 分），平均主动前屈 139°（范围，90°-180°），平均主动外旋 27°（范围，0°-45°）。平均美国肩肘外科评分疼痛评分为 0.7 分（范围，0-5 分），平均视觉模拟评分疼痛评分为 1.1 分（范围，0-5 分）。30 例患者中有 3 例（10%）出现并发症。
短期来看，反式全肩关节置换术缓解了疼痛，改善了功能。并发症发生率与其他治疗方法相比具有优势。
IV 级，治疗性研究。欲了解完整的证据等级描述，请参见作者指南。
