Li Yu, Zhang Hao, Wang Lizhi, Zheng Qiu, Xiao Shizhuo, Yang Hongbin
Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.
Department of Orthopacdics, the People's Hospital of Linshui, Linshui Sichuan, 638500, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):184-189. doi: 10.7507/1002-1892.201907079.
To summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture.
Between June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months).
All the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L in 8 cases, T in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion ( <0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores ( <0.05). X-ray films showed that no prosthesis loosening occurred.
Two-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.
总结两期翻修全肩关节置换术治疗肱骨近端骨折内固定术后深部感染的疗效。
2014年6月至2018年1月，治疗17例肱骨近端骨折内固定术后出现深部感染并伴有肱骨头坏死或骨不连的患者。其中男性8例，女性9例，年龄52至78岁（平均63.8岁）。感染发生在初次内固定术后19至66个月（平均34.8个月）。关节液微生物培养14例阳性，3例阴性。术前Constant评分、美国肩肘外科医师（ASES）评分及视觉模拟评分（VAS）分别为36.41±8.65、31.06±7.43和7.29±0.99。术前前屈、外展、外旋活动度分别为（45.88±12.46）°、（42.18±12.31）°和（16.76±4.92）°。术前内旋活动度，9例为臀部，3例为腰骶关节，5例为腰。一期手术时，彻底清创，取出内固定后植入含抗生素骨水泥间隔物。感染消失后，行两期翻修全肩关节置换术。两次手术的平均间隔时间为4.2个月（范围3.0至6.5个月）。
所有切口均一期愈合，未发生感染复发、血管神经损伤等并发症。所有患者均获随访15至32个月（平均22.0个月）。末次随访时，前屈、外展、外旋活动度分别为（109.00±23.66）°、（98.53±16.92）°、（41.41±6.82）°；内旋活动度，5例为腰骶关节，8例为腰，4例为胸。末次随访时肩关节活动度较术前明显改善（P<0.05）。Constant评分（64.88±8.70）、ASES评分（65.18±8.10）及VAS评分（2.94±1.25）均明显优于术前（P<0.05）。X线片显示无假体松动。
两期翻修全肩关节置换术是治疗肱骨近端骨折内固定术后深部感染的有效方法，具有感染复发风险低、肩关节功能良好、短期疗效满意等优点。
