Lopiz Yaiza, García-Coiradas Javier, Serrano-Mateo Laura, García-Fernández Carlos, Marco Fernando
Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain.
Int Orthop. 2016 Apr;40(4):771-81. doi: 10.1007/s00264-015-3085-z. Epub 2016 Jan 18.
Reverse shoulder arthroplasty (RSA) in fractures is especially indicated in patients of advanced age, although the influence of age on functional outcomes, health-related quality of life (HRQoL) and complication rate is unknown. We hypothesized that complication rate would decrease in the geriatric population because of their reduced activity, improving the perceived HRQoL.
Retrospective study of 42 patients with proximal humeral fractures treated with RSA, divided into two groups: <80 years (<80y)(n = 16) and ≥80 years (≥80y)(n = 26). The assessment tools used were radiological images (functional outcome) with the Constant-Murley score(CMS); disabilities of the arm, shoulder and hand (DASH) score; and HRQoL with the EQ-5D index. Mean follow-up time was 32.6 months.
Mean CMS adjusted for age and sex (R-CMS) was 68 % ± 29 %. Patients in the ≥80y group had a lower total CMS, 33 vs 64 (p = 0.027). Mean active range of motion at 24 months <80y/≥80y was: forward flexion: 126°/110°; abduction: 117°/105°; external rotation: 22°/20°; and internal rotation: L3/sacrum. Mean EQ-VAS was 74 ± 16 in the <80y group, and 63 ± 12.6 in the ≥80y group. Mean DASH was 29.5 ± 9.2. The EQ-5D "self-care" item in the >80y group was the most affected. The "pain/discomfort" item was lower for the two age groups than for the reference population. There were 9.5 % complications: one prosthesis dislocation, one periprosthetic fracture and two surgical wound haematoma.
Our results indicate that age is a critical factor for RSA success. Lower functional outcomes have been obtained in patients older than 80y, although the EQ-5D results in our sample were similar or even better than the referred population.
Level III.
尽管年龄对功能结局、健康相关生活质量（HRQoL）及并发症发生率的影响尚不清楚，但肱骨近端骨折的反肩关节置换术（RSA）尤其适用于老年患者。我们推测老年人群的并发症发生率会因活动减少而降低，从而改善其主观感受的HRQoL。
对42例行RSA治疗的肱骨近端骨折患者进行回顾性研究，分为两组：<80岁（<80y）（n = 16）和≥80岁（≥80y）（n = 26）。使用的评估工具包括采用Constant-Murley评分（CMS）的放射学影像（功能结局）、手臂、肩部和手部功能障碍（DASH）评分以及采用EQ-5D指数的HRQoL。平均随访时间为32.6个月。
经年龄和性别校正后的平均CMS（R-CMS）为68%±29%。≥80岁组患者的总CMS较低，分别为33和64（p = 0.027）。<80岁/≥80岁组在24个月时的平均主动活动范围为：前屈：126°/110°；外展：117°/105°；外旋：22°/20°；内旋：L3/骶骨。<80岁组的平均EQ-VAS为74±16，≥80岁组为63±12.6。平均DASH为29.5±9.2。≥80岁组的EQ-5D“自我护理”项目受影响最大。两个年龄组的“疼痛/不适”项目均低于参考人群。并发症发生率为9.5%：1例假体脱位、1例假体周围骨折和2例手术伤口血肿。
我们的结果表明年龄是RSA成功的关键因素。80岁以上患者的功能结局较差，尽管我们样本中的EQ-5D结果与参考人群相似甚至更好。
三级。
