Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA.
Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA.
J Shoulder Elbow Surg. 2019 Apr;28(4):792-801. doi: 10.1016/j.jse.2018.08.033. Epub 2018 Nov 26.
Reverse total shoulder arthroplasty (RSA) accounts for nearly one-third of shoulder arthroplasty utilization nationally. The complication rate has increased concurrently. Consensus is lacking regarding the incidence, etiology, and treatment of acromial or scapular spine fractures after RSA. The purpose of our study was to perform a systematic review of the literature to analyze the occurrence and outcomes of this complication.
The MEDLINE, Embase, Google Scholar, and Cochrane databases were queried in late 2017 for combinations of the words "acromial," "fracture," "reverse," "shoulder," and "arthroplasty." We included all studies that contained a clearly defined performance of RSA, acromial fracture(s) noted, and treatment (if any) and outcomes of treatment. The initial search yielded 50 studies; 32 met the inclusion criteria.
Among 3838 RSAs, 159 acromial fractures were reported, for an overall incidence of 4.14%; the mean time to diagnosis from surgery was 9 months (range, 1.3-24 months). Treatments included nonoperative treatment in a sling or abduction brace in 139 cases and open reduction-internal fixation in 20. Regardless of treatment, patients reported inferior function after fracture compared with initially after RSA. Forward flexion was 95° (range, 30°-110°), abduction was 76° (range, 30°-180°), the Constant score was 63 (range, 59-67.5), and the American Shoulder and Elbow Surgeons score was 57 (range, 7-83); all values were reduced compared with patients without fractures.
This study suggests the occurrence of acromial fractures after RSA is a common event, with a rate of over 4%. These fractures correlate with worse postoperative outcomes regardless of treatment method; open reduction-internal fixation was not shown to be clinically superior despite a limited complication rate. Additional high-quality studies addressing acromial spine fracture after RSA are needed.
反向全肩关节置换术（RSA）在全国范围内占肩关节置换术的近三分之一。其并发症发生率也随之增加。目前对于 RSA 后肩峰或肩胛脊柱骨折的发生率、病因和治疗方法尚未达成共识。本研究旨在对文献进行系统回顾，以分析该并发症的发生情况和结局。
2017 年末，我们在 MEDLINE、Embase、Google Scholar 和 Cochrane 数据库中检索了“肩峰”、“骨折”、“反向”、“肩”和“关节成形术”等词的组合。我们纳入了所有明确进行 RSA 手术、明确指出肩峰骨折（s）且（如果有）对骨折进行治疗以及报告了治疗结局的研究。最初的检索结果有 50 项研究，其中 32 项符合纳入标准。
在 3838 例 RSA 中，报告了 159 例肩峰骨折，总体发生率为 4.14%；从手术到诊断的平均时间为 9 个月（范围为 1.3-24 个月）。治疗方法包括 139 例使用吊带或外展支具的非手术治疗和 20 例切开复位内固定。无论治疗方法如何，骨折后的患者报告的功能均劣于最初 RSA 后。前屈为 95°（范围为 30°-110°），外展为 76°（范围为 30°-180°），Constant 评分为 63（范围为 59-67.5），美国肩肘外科医生评分（ASES）为 57（范围为 7-83）；所有评分均低于无骨折的患者。
本研究表明 RSA 后肩峰骨折的发生率较高，超过 4%。无论治疗方法如何，这些骨折与术后结局较差相关；尽管并发症发生率较低，但切开复位内固定并未显示出明显的临床优势。需要进一步开展高质量的研究，以探讨 RSA 后肩胛脊柱骨折的问题。
