Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2012 Sep 5;94(17):1610-7. doi: 10.2106/JBJS.J.01975.
Unconstrained shoulder arthroplasty is one of several methods for treatment of proximal humeral fracture nonunions. The goal of this study was to define the results and complications of this procedure.
From 1976 to 2007, sixty-seven patients underwent unconstrained shoulder arthroplasty for proximal humeral nonunion and were followed for more than two years. There were forty-nine women and eighteen men with a mean age of sixty-four years and a mean duration of follow-up of nine years (range, two to thirty years). The fracture type according to the Neer classification was two-part in thirty-six patients, three-part in sixteen, and four-part in fifteen. Hemiarthroplasty was performed in fifty-four patients and total shoulder arthroplasty was done in the remaining thirteen.
There were thirty-three excellent or satisfactory results according to the modified Neer rating. Tuberosity healing about the prosthesis occurred in thirty-five shoulders. The mean pain score improved from 8.3 preoperatively to 4.1 at the time of follow-up (p < 0.001). The average active shoulder elevation and external rotation improved from 46° and 26° to 104° and 50° (p < 0.001). Shoulders with anatomic or nearly anatomic healing of the tuberosities had greater active elevation at the time of final follow-up (p = 0.02). There were fourteen complications in twelve patients, with twelve reoperations including five revisions. Kaplan-Meier survivorship with revision as the end point was 97% (95% confidence interval [CI]: 94.3, 100) at one year and 93% (95% CI: 88.0, 99.2) at five, ten, and twenty years.
Shoulder arthroplasty decreases pain and improves function in patients with a proximal humeral nonunion. However, the overall results are satisfactory in less than half of the patients. Tuberosity healing is inconsistent and influences the functional outcome.
非约束性肩关节置换术是治疗肱骨近端骨折不愈合的几种方法之一。本研究的目的是确定该手术的结果和并发症。
1976 年至 2007 年，67 例肱骨近端骨不连患者接受非约束性肩关节置换术，随访时间超过 2 年。其中女性 49 例，男性 18 例，平均年龄 64 岁，平均随访时间 9 年（2 年至 30 年）。根据 Neer 分类，骨折类型为 36 例 2 部分、16 例 3 部分和 15 例 4 部分。54 例患者行半肩关节置换术，其余 13 例患者行全肩关节置换术。
根据改良 Neer 评分，33 例为优或良。35 例假体周围有肩峰愈合。疼痛评分从术前的 8.3 分改善至随访时的 4.1 分（p < 0.001）。主动肩关节抬高和外旋角度分别从 46°和 26°改善至 104°和 50°（p < 0.001）。肩峰有解剖或近乎解剖愈合的患者在最终随访时的主动抬高角度更大（p = 0.02）。12 例患者共 14 例并发症，共 12 例再次手术，其中 5 例为翻修手术。以翻修为终点的 Kaplan-Meier 生存率在 1 年时为 97%（95%可信区间：94.3%，100%），在 5 年、10 年和 20 年时分别为 93%（95%可信区间：88.0%，99.2%）。
肩关节置换术可减轻肱骨近端骨折不愈合患者的疼痛并改善其功能。然而，不到一半的患者的总体效果是满意的。肩峰愈合不一致，影响功能结果。
