Jobin Charles M, Galdi Balazs, Anakwenze Oke A, Ahmad Christopher S, Levine William N
J Am Acad Orthop Surg. 2015 Mar;23(3):190-201. doi: 10.5435/JAAOS-D-13-00190. Epub 2015 Jan 28.
The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.
与切开复位内固定术和半关节置换术通常不可预测且效果不佳相比，反肩关节置换术在治疗老年复杂的三部分和四部分肱骨近端骨折中越来越受欢迎。钢板内固定效果不佳通常是由于肱骨头缺血性坏死、内固定失败以及螺钉穿透肱骨头等并发症所致，而半关节置换术主要的问题是结节吸收、畸形愈合和不愈合导致假性麻痹。对比研究支持在患有复杂肱骨近端骨折的老年患者中使用反肩关节置换术，因为其功能结果和疼痛缓解得到可靠改善。与结节切除、不愈合或吸收后的结果相比，反肩关节置换术中大结节碎片的修复和愈合显示出外旋改善、临床结果改善以及患者满意度提高。通过仔细的术前规划和关注技术细节可以获得满意的结果。
