Andrés-Cano P, Galán A, Arenas J, Del Águila B, Guerado E
Orthopaedic Surgery and Traumatology Department, Hospital Costa del Sol, Autovía A-7. Km-187, 29603, Marbella, Málaga, Spain,
Eur J Orthop Surg Traumatol. 2015 Feb;25(2):273-80. doi: 10.1007/s00590-014-1487-z. Epub 2014 May 29.
The purpose of this study was to analyze functional and radiologic results of a consecutive series of elderly patients who underwent uncemented hemiarthroplasty as primary treatment of complex proximal humeral fractures.
Twenty-one patients with severe proximal humerus fracture (three or four fragments and three- or four-fragment fracture dislocations) were treated with uncemented proximal humerus hemiarthroplasty. Patients were evaluated using the Constant-Murley Score, the Quick scale Disabilities of Arm, Shoulder and Hand (Quick-DASH) Score, range of motion, residual pain, radiographic parameters, and complications including clinical and radiologic data of mobilization.
After a mean postoperative period of 20.57 months (range 12-42 months), the mean Constant-Murley Score was 44 points (20-57), the mean Quick-DASH score was 24 points (16-39), postoperative pain according to a mean visual analogue scale was 1 (0-8), active abduction was 50° (30-135), and active flexion 70° (20-120). There were no cases of infection, deep vein thrombosis, dislocation, blood transfusions, or reoperation because of prosthetic loosening. Bivariate analysis of demographic data, radiologic findings, and other variables showed associations between duration of surgery and a higher Quick-DASH score (0.606; p = 0.037), and the number of sessions of rehabilitation with a higher Quick-DASH score (0.708; p = 0.015).
The results of treatment of severe proximal humerus fractures in the elderly with an uncemented hemiarthroplasty are safe and promising; however, a comparative cohort study (cemented vs. uncemented) and long-term follow-up are still needed.
本研究旨在分析一系列连续接受非骨水泥半关节置换术作为复杂肱骨近端骨折主要治疗方法的老年患者的功能和影像学结果。
21例严重肱骨近端骨折（三或四块骨折以及三或四部分骨折脱位）患者接受了非骨水泥型肱骨近端半关节置换术。使用Constant-Murley评分、手臂、肩部和手部快速残疾量表（Quick-DASH）评分、活动范围、残余疼痛、影像学参数以及包括活动的临床和影像学数据在内的并发症对患者进行评估。
术后平均20.57个月（范围12 - 42个月），Constant-Murley平均评分为44分（20 - 57分），Quick-DASH平均评分为24分（16 - 39分），根据平均视觉模拟量表术后疼痛评分为1分（0 - 8分），主动外展为50°（30 - 135°），主动屈曲为70°（20 - 120°）。没有感染、深静脉血栓形成、脱位、输血或因假体松动而再次手术的病例。对人口统计学数据、影像学发现和其他变量的双变量分析显示，手术时间与较高的Quick-DASH评分之间存在关联（0.606；p = 0.037），康复疗程数量与较高的Quick-DASH评分之间存在关联（0.708；p = 0.015）。
非骨水泥半关节置换术治疗老年严重肱骨近端骨折的结果是安全且有前景的；然而，仍需要进行一项比较队列研究（骨水泥型与非骨水泥型）以及长期随访。
