Russo R, Della Rotonda G, Cautiero F, Ciccarelli M
Orthopedics and Traumatology Department, Pellegrini Hospital, Naples, Italy.
Orthopedics and Traumatology Unit, Ruesch Clinic, Naples, Italy.
Musculoskelet Surg. 2015 Sep;99 Suppl 1:S17-23. doi: 10.1007/s12306-015-0367-y. Epub 2015 May 12.
The aim of this study is to report the clinical and radiological results of reverse total shoulder arthroplasty (rTSA) in elderly patients who have been treated for complex humeral fractures.
From January 2005 to December 2014, we have implanted rTSA for proximal humeral fractures in 95 patients (80 women, 15 men) about 75 years old on average (range 62-95 years). All rates and results on intraoperative and postoperative complications have been collected in a specific database. In all cases we have used a modular implant prosthesis (Lima Corporate, San Daniele del Friuli, Italy). The prosthesis was implanted cementless in 92 cases. Because of the presence of a high percentage of comorbidities in the elderly patients, we have retrospectively analyzed the necessity of a secondary hospitalization, from a week to a 6-month time after the discharge, due to general health problems and specific postoperative shoulder complications. The mean follow-up was 5 years (range 1-9 years) for 70 of 95 patients, 50 of whom had adequate radiographic controls.
None of 95 patients has required a reoperation or a hospitalization for general health problems from 1 week to 6 months postoperative. No early or late infection of prosthesis has been observed. There were seven cases of perioperative complications, three humeral vertical bone fissuring, two glenoid fractures and two cases of deltoid muscle damage. We have had three cases of postoperative hematoma and one case of ulnar nerve neuropathy. The mean constant score was 85.4, and the mean simple shoulder test was 7.4. We have observed a grade 1 scapular notching in 15 cases (30 %). In the remaining 35 reviewed cases, there was no notching. Peri-articular heterotopic ossifications were found in 11 cases (22 %).
Reverse shoulder prosthesis in complex humeral fractures in the elderly can be considered as a reliable surgical procedure, which leads to very good clinical and radiological results in case of cementless prosthesis, as well.
本研究旨在报告为治疗复杂肱骨骨折的老年患者行反式全肩关节置换术（rTSA）的临床及影像学结果。
2005年1月至2014年12月，我们为95例肱骨近端骨折患者（80例女性，15例男性）植入了rTSA，患者平均年龄约75岁（范围62 - 95岁）。术中及术后并发症的所有发生率及结果均收集于一个特定数据库中。所有病例均使用模块化植入假体（意大利弗留利自由圣丹尼尔的利马公司）。92例患者的假体采用非骨水泥植入。由于老年患者合并症比例较高，我们回顾性分析了出院后1周内至6个月因一般健康问题及特定术后肩部并发症而再次住院的必要性。95例患者中的70例平均随访5年（范围1 - 9年），其中50例有足够的影像学检查。
95例患者术后1周内至6个月均无需因一般健康问题再次手术或住院。未观察到假体的早期或晚期感染。围手术期并发症有7例，包括3例肱骨垂直骨裂、2例肩胛盂骨折和2例三角肌损伤。有3例术后血肿和1例尺神经神经病变。Constant评分平均为85.4，简单肩关节测试平均为7.4。我们观察到15例（30%）出现1级肩胛切迹。在其余35例复查病例中，未出现切迹。11例（22%）发现关节周围异位骨化。
老年复杂肱骨骨折行反式肩关节假体置换术可被视为一种可靠的手术方法，对于非骨水泥假体而言，其临床及影像学结果也非常良好。
