Giardella Antonio, Ascione Francesco, Mocchi Mattia, Berlusconi Marco, Romano Alfonso Maria, Oliva Francesco, Maradei Leonardo
Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy.
Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy.
Muscles Ligaments Tendons J. 2017 Sep 18;7(2):271-278. doi: 10.11138/mltj/2017.7.2.271. eCollection 2017 Apr-Jun.
Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly.
The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control.
We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required.
Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients.
Level IV, Case Series, Surgical.
移位型肱骨近端骨折的治疗仍存在争议。老年患者肩袖功能差及结节不愈合，使得反式全肩关节置换术越来越受欢迎，即使与角稳定钢板固定相比，也显示出良好的效果。本研究旨在报告老年患者采用反式全肩关节置换术（rTSA）或切开复位内固定术（ORIF）治疗肱骨近端骨折的临床及影像学结果。
本研究回顾性调查了2009年1月至2014年6月期间连续收治的73例65岁以上（年龄范围65 - 91岁）肱骨近端三部分和四部分骨折患者，这些患者接受了反式全肩关节置换术或使用角稳定钢板进行切开复位内固定术，且随访时间至少为1年。根据AO - OTA分型为11 - B2或11 - C2型的移位型肱骨近端骨折患者被纳入我院。主要观察指标为主动活动范围（ROM）和肩关节功能（Constant评分）。次要观察指标为患者自我评估表（简单肩关节测试）和影像学细节。随访在临床观察时进行，并进行X线检查。
我们分析了一组23例采用钢板螺钉治疗的患者和21例采用rTSA治疗的患者的平均结果。ORIF组：前屈112.8°，外展99.6°，90°外旋47.4°，内旋手触及骶髂关节时的模式值，Constant评分为52.9，简单肩关节测试评分为8.0。RSA组：前屈133.3°，外展101.4°，外展90°时外旋35.5°，内旋手触及腰部（L3）时的模式值，Constant评分为65.9，简单肩关节测试评分为9.2。未报告神经损伤。无假关节或钢板骨折病例。未记录到关节成形术植入物松动、感染或脱位情况，也无需翻修。
我们的研究表明，两种治疗方法均具有良好的临床效果且并发症较少。与ORIF相比，RSA在临床和日常生活方面的结果更好，证实rTSA是老年肱骨近端骨折患者的最佳治疗方法之一，这些患者的肩袖功能通常较差且已退变。两组患者的少数影像学并发症似乎对主动ROM和Constant评分均无影响。
IV级，病例系列，外科手术。
