肱骨近端畸形愈合（4型骨折后遗症）的反肩关节置换术

Reverse Shoulder Arthroplasty for Malunions of the Proximal Part of the Humerus (Type-4 Fracture Sequelae).

作者信息

Raiss Patric, Edwards T Bradley, Collin Philippe, Bruckner Thomas, Zeifang Felix, Loew Markus, Boileau Pascal, Walch Gilles

机构信息

Zentrum für Orthopädie und Unfallchirurgie (P.R. and F.Z.) and Institute of Medical Biometry and Informatics (T.B. and M.L.), Universität Heidelberg, Heidelberg, Germany

Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas.

出版信息

J Bone Joint Surg Am. 2016 Jun 1;98(11):893-9. doi: 10.2106/JBJS.15.00506.

DOI:10.2106/JBJS.15.00506

PMID:27252433

Abstract

BACKGROUND

The treatment of fracture sequelae of the proximal part of the humerus in combination with posttraumatic arthritis is challenging. The reported results of treatment with anatomic shoulder arthroplasty are disappointing. The aim of this multicenter study was to analyze the clinical and radiographic results of reverse shoulder arthroplasty for treatment of posttraumatic sequelae of the proximal part of the humerus with malunion of the tuberosities.

METHODS

This was a retrospective, multicenter study of 42 patients (42 shoulders) with the diagnosis of posttraumatic sequelae of the proximal part of the humerus with malunions of the tuberosities who were treated with reverse shoulder arthroplasty between 2000 and 2010. The mean age at the time of arthroplasty was 68 years (range, 27 to 83 years; median, 70 years). The dominant side was treated in 24 cases. The mean clinical and radiographic follow-up was 4 years (range, 2 to 13 years; median, 3.5 years). The Constant score including subgroups, shoulder flexion, rotation motion, and radiographs of the affected shoulders were analyzed before the surgical procedure and at the time of the latest follow-up. Patients categorized their postoperative results as very good, good, satisfactory, or unsatisfactory.

RESULTS

The mean Constant score increased from 19.7 points (range, 0 to 52 points) preoperatively to 54.9 points (range, 21 to 83 points) postoperatively (p < 0.0001). All of the subgroups of the Constant score also increased, as did active shoulder flexion and external rotation (all p < 0.0001). In one case, loosening of the humeral and glenoid components occurred. Scapular notching was present in 22 shoulders (52%) and was grade 1 in 12 cases, grade 2 in 4 cases, grade 3 in 2 cases, and grade 4 in 4 cases. Complications occurred in 4 patients (9.5%). Eighteen patients (43%) rated their result as very good, 19 (45%) rated their result as good, 4 (10%) rated their result as satisfactory, and one (2%) rated the result as unsatisfactory.

CONCLUSIONS

Reverse shoulder arthroplasty is a viable treatment option for type-4 proximal humeral fracture sequelae that cannot otherwise be treated with anatomic shoulder replacement.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

肱骨近端骨折后遗症合并创伤后关节炎的治疗具有挑战性。解剖型肩关节置换术的治疗效果令人失望。这项多中心研究的目的是分析反肩关节置换术治疗肱骨近端骨折畸形愈合创伤后后遗症的临床和影像学结果。

方法

这是一项回顾性多中心研究，纳入了2000年至2010年间接受反肩关节置换术治疗的42例（42肩）诊断为肱骨近端骨折畸形愈合创伤后后遗症的患者。置换术时的平均年龄为68岁（范围27至83岁；中位数70岁）。24例为优势侧。平均临床和影像学随访时间为4年（范围2至13年；中位数3.5年）。分析手术前和最新随访时的Constant评分（包括亚组）、患肩的前屈、旋转运动及X线片。患者将术后结果分为非常好、好、满意或不满意。

结果

Constant评分的平均值从术前的19.7分（范围0至52分）增加到术后的54.9分（范围21至83分）（p < 0.0001）。Constant评分的所有亚组以及主动肩前屈和外旋均增加（均p < 0.0001）。1例出现肱骨和肩胛盂假体松动。22例（52%）出现肩胛盂切迹，其中12例为1级，4例为2级，2例为3级，4例为4级。4例患者（9.5%）发生并发症。18例患者（43%）将结果评为非常好，19例（45%）评为好，4例（10%）评为满意，1例（2%）评为不满意。