Rosas Samuel, Law Tsun Yee, Kurowicki Jennifer, Formaini Nate, Kalandiak Steven P, Levy Jonathan C
Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.
Shoulder and Elbow Department, Holy Cross Hospital, Fort Lauderdale, FL, USA.
J Shoulder Elbow Surg. 2016 Apr;25(4):608-13. doi: 10.1016/j.jse.2015.08.011. Epub 2015 Oct 21.
Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population.
We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated.
Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (P = .119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% (P < .001). The utilization rate decreased significantly for HA from 52% to 39% (P < .001), increased significantly for RSA from 11% to 28% (P < .001), and did not change significantly for ORIF (P = .164). The utilization rate of RSA nearly tripled for patients older than 65 years (11% to 29%) and doubled for patients younger than 65 (6% to 12%).
From 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA.
据报道，近年来肱骨近端骨折的手术治疗有所增加。这种增长很大程度上与老年人口的增加有关，同时也与现代植入物的引入有关，如锁定钢板，以及最近反向肩关节置换术（RSA）的引入。本研究通过分析医疗保险患者群体中半关节置换术（HA）、RSA和骨固定术（切开复位内固定术[ORIF]）的使用情况，评估了2009年至2012年肱骨近端骨折手术治疗的趋势。
我们回顾性地研究了PearlDiver超级计算机（美国印第安纳州华沙）内一个全面的医疗保险患者群体数据库，以了解接受HA、RSA或ORIF治疗的肱骨近端骨折情况。调查了总使用量、年使用率、年龄和性别。
在研究期间，32150例肱骨近端骨折接受了手术治疗，年手术量无显著变化（P = 0.119）。手术治疗骨折的比例从16.2%显著下降至13.9%（P < 0.001）。HA的使用率从52%显著下降至39%（P < 0.001），RSA的使用率从11%显著上升至28%（P < 0.001），ORIF的使用率无显著变化（P = 0.164）。65岁以上患者的RSA使用率几乎增加了两倍（从11%增至29%），65岁以下患者的使用率增加了一倍（从6%增至12%）。
2009年至2012年，ORIF的使用率保持相当稳定。HA仍然是医疗保险人群中肱骨近端骨折最常用的手术治疗方法，但其使用量已显著下降。这种下降已被RSA相应的增加所抵消。
