Orthopedic Practice Clinic (OPPK) and Raphaelsklinik Münster, Münster, Germany.
Orthopedic Practice Clinic (OPPK), Münster, Germany.
Bone Joint J. 2018 Jun 1;100-B(6):761-766. doi: 10.1302/0301-620X.100B6.BJJ-2017-1280.R1.
The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA.
A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs.
At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018).
After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761-6.
半肩置换术（HA）治疗肱骨近端骨折失败的原因包括肩袖撕裂、结节移位或坏死、干骺端骨量不足。在这些患者中，反式全肩关节置换术（rTSA）通常是唯一的治疗方法。本研究的目的是评估 HA 治疗失败后转换为 rTSA 的临床结果。
共有 35 例 HA 治疗肱骨近端骨折失败的患者接受了 rTSA 转换。28 例患者在平均 61 个月（37 至 91 个月）的随访中获得了可评估结果，这些患者在术后平均 20 个月（12 至 36 个月）时进行了初次评估。有可转换设计的情况下，9 例患者保留了肱骨柄。另外 19 例患者去除了肱骨柄并植入了传统的 rTSA。末次随访时，采用美国肩肘外科医生（ASES）评分、Constant 评分和普通 X 线片对患者进行评估。
末次随访时，平均 ASES 评分为 59（25 至 97），平均调整后的 Constant 评分为 63%（23%至 109%）。两者均有显著改善（p < 0.001）。平均前屈为 104°（50°至 155°），平均外展为 98°（60°至 140°）。9 例患者（32%）出现并发症，分别有 2 例感染和不稳定，3 例肩胛骨骨折，1 例分别有延迟愈合和症状性松动。如果植入物可以在不取出肱骨柄的情况下转换为 rTSA，则手术时间更短（82 分钟比 102 分钟；p = 0.018）。
肱骨近端骨折 HA 治疗失败后，转换为 rTSA 可能会减轻疼痛并改善肩部功能。但并发症发生率较高。
