Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, South Korea.
Department of Orthopaedic Surgery, Ujeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, South Korea.
Arch Orthop Trauma Surg. 2019 Dec;139(12):1649-1657. doi: 10.1007/s00402-019-03190-y. Epub 2019 Apr 20.
Fracture stem of the reverse total shoulder arthroplasty (RTSA) was designed for better tuberosity bone healing for the proximal bone defect of complex proximal humeral fractures (PHF). Our purpose was to compare the clinical and radiological outcomes of patients using fracture stem vs non-fracture (conventional) stem of RTSA in complex PHF of elderly patients.
Between 2008 March and 2017 June, 48 patients who had undergone an RTSA with non-fracture or fracture stem for complex PHF with a minimum 18 months of follow-up were evaluated. Finally, total 45 patients with a mean age of 80 ± 7 years (65-92 years) were enrolled because three patients were excluded due to age related mortality. We divided them into two groups: 25 patients using non-fracture stem (non-fracture stem group) in the early period of this study, and consecutive 20 patients using fracture stem (fracture stem group) in the later period. Between two groups, we compared clinical and radiologic outcomes such as tuberosity failure, heterotopic ossification (HO), dislocation, acromion fracture, notching, loosening and periprosthetic fracture.
In all patients, clinical outcomes were improved significantly and tuberosity failure was found in 62% (28/45). Between two groups, there were no statistically significant differences on clinical outcomes and radiologic outcomes except UCLA score. As complications, two humeral stem revision was performed due to tuberosity failure related HO and stem loosening with subsequent periprosthetic fracture in non-fracture stem group.
Compared to non-fracture stem, fracture stem usage of RTSA in complex PHF of elderly patients has no significant different impact on clinical and radiological outcomes. However, tuberosity failure related secondary HO of non-fracture stem might be responsible for stem loosening and periprosthetic fracture in the RTSA for complex PHF of elderly patients.
Level IV, case series study.
反式全肩关节置换术（RTSA）的骨折干骺端设计用于更好地促进复杂肱骨近端骨折（PHF）的近端骨缺损处的肩袖愈合。我们的目的是比较在老年复杂 PHF 患者中使用 RTSA 的骨折干骺端与非骨折（常规）干骺端的临床和影像学结果。
2008 年 3 月至 2017 年 6 月，对 48 例接受非骨折或骨折干骺端 RTSA 治疗的复杂 PHF 患者进行了评估，随访时间至少 18 个月。最终，共纳入 45 例平均年龄 80±7 岁（65-92 岁）的患者，因为有 3 例患者因年龄相关死亡而被排除。我们将他们分为两组：25 例患者在研究早期使用非骨折干骺端（非骨折干骺端组），20 例患者在后期使用骨折干骺端（骨折干骺端组）。在两组之间，我们比较了临床和影像学结果，如肩袖失败、异位骨化（HO）、脱位、肩峰骨折、切迹、松动和假体周围骨折。
所有患者的临床结果均显著改善，肩袖失败率为 62%（28/45）。在两组之间，除 UCLA 评分外，临床和影像学结果均无统计学差异。并发症方面，非骨折干骺端组有 2 例因肩袖失败相关的 HO 和干骺端松动导致的肱骨干假体翻修，随后发生假体周围骨折。
与非骨折干骺端相比，老年复杂 PHF 患者使用 RTSA 的骨折干骺端对临床和影像学结果没有显著影响。然而，非骨折干骺端的肩袖失败相关的继发性 HO 可能导致 RTSA 治疗老年复杂 PHF 患者的干骺端松动和假体周围骨折。
IV 级，病例系列研究。
