Schairer William W, Nwachukwu Benedict U, Lyman Stephen, Gulotta Lawrence V
a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA.
Phys Sportsmed. 2017 May;45(2):92-96. doi: 10.1080/00913847.2017.1311199. Epub 2017 Mar 31.
Proximal humerus fractures are a common injury in the elderly population that can usually be managed non-operatively. However, arthroplasty has become increasingly utilized for complex fractures and poor bone quality. We evaluated national trends in treatment, specifically looking at the adoption of reverse total shoulder arthroplasty.
The incidence of proximal humerus fractures was calculated from the Nationwide Emergency Department Database (NEDD) from 2006 to 2012. The Nationwide Inpatient Sample (NIS) was used to select patients from 2000 to 2013 with proximal humerus fractures treated with open reduction and internal fixation (ORIF), total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and hemiarthroplasty (HSA). RSA and TSA shared the same ICD-9 code until 2010.
The incidence of proximal humerus fracture was stable from 2006 to 2012. Hemiarthroplasty was the majority treatment choice for arthroplasty in the early 2000's. However, in 2008, there was a large decrease in utilization, to 51.3% in 2013. During this period, utilization of TSA greatly increased, coinciding with a large increase of RSA. By 2013, RSA made up 45.1% of arthroplasty procedures.
The rate of proximal humerus fracture appears stable, while we observed both an overall increase in operative intervention. RSA appears to be increasingly chosen over HSA for arthroplasty treatment of proximal humerus fractures, an observation more pronounced in older patients. While clinical results appear promising, it is important to remember that most proximal humerus fractures may be treated successfully with conservative management, and rapid adoption of new technology should be watched carefully to ensure appropriate use.
肱骨近端骨折是老年人群中的常见损伤，通常可采用非手术治疗。然而，关节成形术在复杂骨折和骨质不佳的情况下使用得越来越多。我们评估了治疗的全国趋势，特别关注反式全肩关节置换术的采用情况。
从2006年至2012年的全国急诊科数据库（NEDD）中计算肱骨近端骨折的发病率。使用全国住院患者样本（NIS）选取2000年至2013年接受切开复位内固定（ORIF）、全肩关节置换术（TSA）、反式全肩关节置换术（RSA）和半关节置换术（HSA）治疗的肱骨近端骨折患者。直到2010年，RSA和TSA共享相同的ICD-9编码。
2006年至2012年肱骨近端骨折的发病率稳定。在21世纪初，半关节置换术是关节成形术的主要治疗选择。然而，在2008年，其使用率大幅下降，到2013年降至51.3%。在此期间，TSA的使用率大幅上升，与RSA的大幅增加同时出现。到2013年，RSA占关节成形术手术的45.1%。
肱骨近端骨折的发生率似乎稳定，而我们观察到手术干预总体上有所增加。在肱骨近端骨折的关节成形术治疗中，RSA似乎比HSA越来越多地被选择，这一观察结果在老年患者中更为明显。虽然临床结果似乎很有前景，但重要的是要记住，大多数肱骨近端骨折可以通过保守治疗成功治愈，应密切关注新技术的迅速采用，以确保合理使用。
