Boyer E, Menu G, Loisel F, Saadnia R, Uhring J, Adam A, Rochet S, Clappaz P, Baudouin E, Lascar T, Cermeno R, Obert L
Orthopedic, Traumatology, and Hand Surgery Unit, CHRU Besancon - University of Bourgogne - Franche Comte, Bd Fleming, 25030, Besançon, France.
Clinique Convert - Bourg-en-Bresse, 62 Avenue de Jasseron, 01000, Bourg-en-Bresse, France.
Eur J Orthop Surg Traumatol. 2017 Apr;27(3):301-308. doi: 10.1007/s00590-017-1926-8. Epub 2017 Feb 25.
Cemented stem remains the gold standard for prosthesis in trauma. The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem (hemi and reverse) for 3- and 4-part proximal humeral fractures.
One hundred and thirty-four 3- and 4-part fractures have been treated by locked stem, 69 with hemiarthroplasty [mean age 68 years (50-90)] and 65 with reversed [mean age 78 years (66-91)]. The length of the stem was 15 cm with a proximal coating of HA automatic locking system (two screws) and four different diameters. Preliminary cadaver study allowed us to validate the system (22 shoulders, no injuries of nerves, locking system efficient).
In the group of hemi, Constant score with ponderation reached 72 (11-120) and QDash 31.2 (4.5-77.27) with a mean FU of 25 months (6-96). In the group of reversed, Constant score with ponderation reached 77.6 (28.8-119) and QDash 36.2 (2-84) with a mean FU of 15 months (6-41). Specific complications due to locking system reached 3% but without reoperation. Other complications were capsulitis and infection.
In this population of elderly patient, new fall with periprosthetic fracture or infection led the surgeon to remove the stem. At shoulder level, the removal of a cemented stem remains a highly demanding procedure with sometimes bad functional results and elevated level of complications. This series is the first one of locked stem without significant complications. Locked stem remains a new but logical tool in trauma.
骨水泥型柄仍是创伤性假体的金标准。本研究的目的是评估一种用于治疗三部分和四部分近端肱骨骨折的非骨水泥型、创伤专用锁定柄（半肩关节置换和反肩关节置换）的功能和影像学结果。
134例三部分和四部分骨折采用锁定柄治疗，69例行半肩关节置换术（平均年龄68岁，50 - 90岁），65例行反肩关节置换术（平均年龄78岁，66 - 91岁）。柄的长度为15 cm，近端有羟基磷灰石自动锁定系统涂层（两枚螺钉），有四种不同直径。初步尸体研究使我们能够验证该系统（22个肩关节，无神经损伤，锁定系统有效）。
在半肩关节置换组，加权后的Constant评分达到72（11 - 120），QDash评分为31.2（4.5 - 77.27），平均随访时间为25个月（6 - 96个月）。在反肩关节置换组，加权后的Constant评分达到77.6（28.8 - 119），QDash评分为36.2（2 - 84），平均随访时间为15个月（6 - 41个月）。锁定系统导致的特定并发症发生率为3%，但无需再次手术。其他并发症为肩周炎和感染。
在这组老年患者中，新的假体周围骨折或感染导致外科医生取出柄。在肩关节层面，取出骨水泥型柄仍然是一项要求很高的手术，有时功能结果不佳且并发症发生率较高。本系列是首个无明显并发症的锁定柄病例系列。锁定柄仍是创伤治疗中一种新的但合理的工具。
