Schairer William W, Nwachukwu Benedict U, Lyman Stephen, Craig Edward V, Gulotta Lawrence V
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2015 Oct;24(10):1560-6. doi: 10.1016/j.jse.2015.03.018. Epub 2015 May 7.
Whereas most proximal humerus fractures are treated nonoperatively, complex 3- and 4-part fractures may require shoulder arthroplasty. Hemi-shoulder arthroplasty (HSA) has been the standard treatment, but recently there has been discussion and utilization of reverse total shoulder arthroplasty (RTSA) as a viable treatment option. This study evaluated the national utilization of RTSA and HSA for proximal humerus fractures and compared patient and hospital characteristics associated with each procedure.
This study used the Nationwide Inpatient Sample database for 2011, which allows national estimates of inpatient hospital discharges. Patients were selected by diagnosis and procedure codes to identify those who underwent RTSA or HSA for treatment of proximal humerus fractures. Patient and hospital characteristics associated with each procedure as well as in-hospital complication rates were identified.
An estimated 7714 patients with proximal humerus fractures were selected, 27.4% of whom were treated with RTSA. Except for increased age, patient characteristics were similar between groups, as were complication rates. RTSA was more likely to be performed over HSA in small, rural, nonteaching hospitals and also in those that had already adopted and performed a high volume of RTSA procedures for other diagnoses.
Although HSA remains the most common arthroplasty choice for proximal humerus fractures, RTSA is becoming widely used. Patient characteristics and complications were similar between the 2 procedures, and as clinical evidence appears to show improved outcomes with RTSA, it is likely that acceptance of RTSA will continue to grow.
尽管大多数肱骨近端骨折采用非手术治疗，但复杂的三部分和四部分骨折可能需要进行肩关节置换术。半肩关节置换术（HSA）一直是标准治疗方法，但最近关于反式全肩关节置换术（RTSA）作为一种可行治疗选择的讨论和应用不断增加。本研究评估了RTSA和HSA在全国范围内用于治疗肱骨近端骨折的情况，并比较了与每种手术相关的患者和医院特征。
本研究使用了2011年全国住院患者样本数据库，该数据库可对全国住院患者出院情况进行估计。通过诊断和手术编码选择患者，以识别那些接受RTSA或HSA治疗肱骨近端骨折的患者。确定了与每种手术相关的患者和医院特征以及院内并发症发生率。
估计共选择了7714例肱骨近端骨折患者，其中27.4%接受了RTSA治疗。除了年龄增加外，两组患者的特征相似，并发症发生率也相似。在小型农村非教学医院以及那些已经为其他诊断采用并实施了大量RTSA手术的医院中，RTSA比HSA更有可能被实施。
尽管HSA仍然是肱骨近端骨折最常见的关节置换选择，但RTSA正被广泛使用。两种手术的患者特征和并发症相似，而且正如临床证据似乎显示RTSA的治疗效果有所改善一样，RTSA的接受度可能会继续提高。
