Chernchujit Bancha, Prasetia Renaldi
1 Faculty of Medicine, Department of Orthopaedic Surgery, Thammasat University, Rangsit, Thailand.
2 Faculty of Medicine, Department of Orthopaedic Surgery, Universitas Padjadjaran, Bandung, Indonesia.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017754104. doi: 10.1177/2309499017754104.
Tuberosity healing is known to be one of the factors that increase functional outcome in Reverse Total Shoulder Arthroplasty (rTSA). In fragility fractures, tuberosity healing is difficult to be achieved. The fragment stability and bone-forming agent application become strategies to overcome this problem. The purpose of this study was to evaluate the benefit of teriparatide application to promote tuberosity union in rTSA on four-part proximal humeral fractures to achieve better functional outcome.
A retrospective study of a prospectively collected shoulder arthroplasty medical record was performed. Eleven patients were included in this analysis and consisted of two groups, teriparatide and no-teriparatide groups. Patients were evaluated on the range of motions and clinical outcome using the American Shoulder Elbow Surgeon (ASES) Shoulder Score and X-ray to determine tuberosity union. The group differences were analyzed by t-test or Mann-Whitney U test with SPSS version 20.0 for Windows.
The statistical analysis revealed no significant differences in mean age in both the groups. There were significant differences between teriparatide and no-teriparatide groups in external rotation (29.5° vs. 7.5°; p = 0.004), external rotation in 90° abduction (55° vs. 12.5°; p < 0.020), forward flexion (120° vs. 105°; p = 0.002) range of motions, and ASES (84.5 vs. 74.6; p = 0.019). We found clinical difference between teriparatide and no-teriparatide groups in time to achieve the initial callus (33 ± 18.3 days vs. 150 ± 42.4 days) and tuberosity consolidation (165.8 ± 70.3 days vs. 315 ± 106.1 days).
Teriparatide administration supports tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after rTSA in acute complex proximal humeral fractures.
已知结节愈合是增加反式全肩关节置换术（rTSA）功能结局的因素之一。在脆性骨折中，结节愈合难以实现。骨折块稳定性和骨形成剂的应用成为克服这一问题的策略。本研究的目的是评估应用特立帕肽促进rTSA治疗四部分肱骨近端骨折时结节愈合以获得更好功能结局的益处。
对前瞻性收集的肩关节置换术病历进行回顾性研究。本分析纳入了11例患者，分为两组，即特立帕肽组和非特立帕肽组。使用美国肩肘外科医生（ASES）肩关节评分对患者的活动范围和临床结局进行评估，并通过X线检查确定结节愈合情况。使用Windows版SPSS 20.0软件，通过t检验或曼-惠特尼U检验分析组间差异。
统计分析显示两组患者的平均年龄无显著差异。特立帕肽组和非特立帕肽组在外旋（29.5°对7.5°；p = 0.004）、90°外展时的外旋（55°对12.5°；p < 0.020）、前屈（120°对105°；p = 0.002）活动范围以及ASES评分（84.5对74.6；p = 0.019）方面存在显著差异。我们发现特立帕肽组和非特立帕肽组在达到初始骨痂形成的时间（33±18.3天对150±42.4天）和结节巩固时间（165.8±70.3天对315±106.1天）上存在临床差异。
在急性复杂肱骨近端骨折的rTSA术后，应用特立帕肽有助于结节修复，可实现较高的结节愈合率并恢复外旋功能。
