Sebastia-Forcada Emilio, Lizaur-Utrilla Alejandro, Cebrian-Gomez Román, Miralles-Muñoz Francisco A, Lopez-Prats Fernando A
*Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; and †Miguel Hernandez University, Elche, Alicante, Spain.
J Orthop Trauma. 2017 Aug;31(8):e236-e240. doi: 10.1097/BOT.0000000000000858.
To compare the outcomes of reverse shoulder arthroplasty (RSA) between patients with failed proximal humeral locking plate (PHLP) fixation and those with acute fractures.
Matched case-control study.
University hospital, Level I trauma center.
Thirty consecutive patients with fracture sequelae because of failed PHLP fixation (mean age 73) were age and sex matched to 30 patients with acute fracture (mean age 75).
All patients underwent RSA.
Constant, University of California Los Angeles (UCLA) and Disability of the Arm, Shoulder and Hand (DASH) scores. Radiological assessments were also performed.
The mean postoperative follow-up was 3.2 (range, 2-5) years. All functional scores significantly improved from preoperative to postoperative (P = 0.001) in the sequelae group. Pain was relieved in all but one patient, and all but 2 patients were satisfied with their RSA. However, the functional outcomes at the last follow-up were significantly worse in the sequelae group compared with acute group in terms of adjusted Constant (P = 0.013), UCLA (P = 0.020) and DASH (P = 0.048) scores, strength (P = 0.01), anterior forward (P = 0.021), and abduction (P = 0.007). Six patients (20%) in the sequelae group had complications including 2 intraoperative (diaphyseal false passages), 2 early dislocations, 1 acromial fracture, and 1 aseptic loosening of glenoid component. Four of these patients were revised resulting all in a successful outcome at the last follow-up. In the acute group there was one intraoperative humeral fracture with no impact on the final outcome.
Patients with failed PHLP fixation for fracture who were revised to RSA secondarily obtained marginally lower functional scores and higher complication rates compared with patients treated with primary RSA for fracture. However, patients who treated with secondary RSA had significant functional improvement and pain relief compared with their preoperative status, and most complications were manageable without a significant effect on final outcome.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较肱骨近端锁定钢板（PHLP）固定失败患者与急性骨折患者行反肩关节置换术（RSA）的疗效。
配对病例对照研究。
大学医院，一级创伤中心。
30例因PHLP固定失败导致骨折后遗症的连续患者（平均年龄73岁），在年龄和性别上与30例急性骨折患者（平均年龄75岁）相匹配。
所有患者均接受RSA手术。
Constant评分、加利福尼亚大学洛杉矶分校（UCLA）评分以及上肢、肩部和手部功能障碍（DASH）评分。同时进行影像学评估。
术后平均随访3.2年（范围2 - 5年）。后遗症组所有功能评分从术前到术后均显著改善（P = 0.001）。除1例患者外，所有患者疼痛均缓解，除2例患者外，所有患者对其RSA手术满意。然而，在末次随访时，后遗症组在调整后的Constant评分（P = 0.013）、UCLA评分（P = 0.020）和DASH评分（P = 0.048）、力量（P = 0.01）、前屈（P = 0.021）和外展（P = 0.007）方面的功能结局明显比急性骨折组差。后遗症组6例患者（20%）出现并发症，包括2例术中并发症（骨干假道）、2例早期脱位、1例肩峰骨折和1例关节盂假体无菌性松动。其中4例患者进行了翻修手术，所有患者在末次随访时均获得成功结局。急性骨折组有1例术中肱骨骨折，但对最终结局无影响。
骨折后PHLP固定失败并二次行RSA手术的患者，与初次行RSA治疗骨折的患者相比，功能评分略低，并发症发生率更高。然而，二次行RSA手术的患者与术前状态相比，功能有显著改善，疼痛缓解，且大多数并发症可处理，对最终结局无显著影响。
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
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