Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.
J Shoulder Elbow Surg. 2013 Jan;22(1):32-7. doi: 10.1016/j.jse.2012.03.006. Epub 2012 May 29.
Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures.
All patients who underwent RSA or shoulder hemiarthroplasty for acute proximal humeral fractures between January 1, 1999, and December 31, 2010 were identified from The New Zealand Joint Registry. Baseline information, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS] at 6 months and 5 years, revision rate, and mortality rate) were examined and compared between the study groups.
During the study period, 55 patients underwent RSA and 313 underwent shoulder hemiarthroplasty for acute proximal humeral fractures. Compared with hemiarthroplasty patients, RSA patients were significantly older (mean age, 79.6 vs 71.9 years; P < .001) and more often women (93% vs 78%, P = .013). The 6-month OSS was 28.1 for RSA and 27.9 for hemiarthroplasty, which was not significantly different (P = .923); however, the RSA group had a significantly better 5-year OSS than the hemiarthroplasty group (41.5 vs 32.3; P = .022). There was no significant difference between the RSA and hemiarthroplasty groups in revision rate per 100 component-years (1.7 vs 1.1; P = .747) or in 1-year mortality (3.5% vs 3.6%; P > .99).
Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.
复杂的急性肱骨近端骨折可能需要肱骨近端假体置换。在这种骨折的治疗中，反肩置换术（RSA）已被建议作为半肩置换术的替代方法。本研究比较了 RSA 与半肩置换术治疗急性肱骨近端骨折患者的功能结果。
从新西兰关节登记处确定了 1999 年 1 月 1 日至 2010 年 12 月 31 日期间接受 RSA 或肩部半肩置换术治疗急性肱骨近端骨折的所有患者。检查并比较了两组患者的基线信息、手术特点和术后结果（6 个月和 5 年的牛津肩部评分[OSS]、翻修率和死亡率）。
在研究期间，55 例患者接受 RSA，313 例患者接受肩部半肩置换术治疗急性肱骨近端骨折。与半肩置换术患者相比，RSA 患者年龄明显较大（平均年龄，79.6 岁比 71.9 岁；P<0.001），女性患者更多（93%比 78%，P=0.013）。RSA 组的 6 个月 OSS 为 28.1，半肩置换术组为 27.9，差异无统计学意义（P=0.923）；然而，RSA 组的 5 年 OSS 明显优于半肩置换术组（41.5 比 32.3；P=0.022）。RSA 组与半肩置换术组的每 100 个组件年的翻修率（1.7 比 1.1；P=0.747）或 1 年死亡率（3.5%比 3.6%；P>0.99）均无显著差异。
与接受半肩置换术的患者相比，接受 RSA 的急性肱骨近端骨折患者似乎获得了更好的 5 年功能结果。
