Instituto de Traumatología Cordobes, Arruzafilla Avenue S/N 14011, Córdoba, Spain.
University Hospital Reina Sofía, Menendez Pidal Avenue, 14004, Córdoba, Spain.
Bone Joint J. 2014 Sep;96-B(9):1239-43. doi: 10.1302/0301-620X.96B9.33157.
Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high.
由于肱骨近端三分之一骨折不愈合导致疼痛和肩部功能丧失的患者可能会从反式全肩关节置换中获益。本文报告了一项前瞻性、多中心研究，涉及三家医院和三位外科医生，共 35 名（28 名女性，7 名男性）年龄 69 岁（46 至 83 岁）的患者接受了反式全肩关节置换术治疗肱骨近端骨折不愈合。使用 Checchia 分类，9 例为 I 型，8 例为 II 型，12 例为 III 型，6 例为 IV 型。平均随访时间为 51 个月（24 至 99 个月）。术后，患者疼痛明显减轻（p<0.001），且屈曲、外展、外旋和 Constant 评分显著改善（p<0.001），但内旋无改善。7 名患者共发生 9 例并发症：6 例脱位，1 例先前有脱位的患者发生肩盂松动，1 例腋神经一过性麻痹，1 例感染。反式全肩关节置换术可显著减轻疼痛，改善功能，提高满意度。然而，并发症，尤其是脱位的发生率较高。
