早期与晚期反肩关节置换术治疗肱骨近端骨折：这重要吗？
Early Versus Late Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Does It Matter?
作者信息
Seidl Adam, Sholder Daniel, Warrender William, Livesey Michael, Williams Gerald, Abboud Joseph, Namdari Surena
机构信息
Department of Orthopedics, The University of Colorado, Aurora, USA.
出版信息
Arch Bone Jt Surg. 2017 Jul;5(4):213-220.
BACKGROUND
This study compared the outcomes between patients with proximal humerus fractures (PHF) who underwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatment before requiring (secondary) RSA.
METHODS
Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was required for inclusion. Patients were divided into an acute group (RSA <4 weeks of fracture) and a secondary group. The secondary RSA group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internal fixation (ORIF)). Clinical and radiographic outcomes were compared.
RESULTS
Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group. The acute RSA group demonstrated better external rotation (28°) than the secondary RSA group (18°, =0.0495). The acute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosity healing rate was higher in the acute RSA group.
CONCLUSION
While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosity healing rate and improved external rotation.
背景
本研究比较了接受急性翻修全肩关节置换术（RSA）的肱骨近端骨折（PHF）患者与那些在需要（二次）RSA之前接受替代初始治疗的患者的治疗结果。
方法
确定了PHF后接受RSA的患者。纳入标准要求进行两年的临床随访。患者分为急性组（骨折后RSA<4周）和二次组。二次RSA组根据初始治疗方法（非手术、半关节置换术、切开复位内固定术（ORIF））进行细分。比较临床和影像学结果。
结果
47例患者符合纳入标准，急性RSA组15例，二次组32例。急性RSA组的外旋角度（28°）优于二次组（18°，P=0.0495）。急性RSA组的单项评估数字评分（SANE）得分有更好的趋势。急性RSA组的结节愈合率更高。
结论
虽然急性和二次RSA都能取得成功的治疗结果，但急性RSA能获得更高的结节愈合率和改善的外旋角度。
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