对于肱骨近端骨折患者行 135°假体的初次反肩关节置换术后，结节愈合可改善功能预后。
Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis.
机构信息
Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Teaching Hospital Albert-Ludwigs-University Freiburg, Suedendstraße 32, 76137, Karlsruhe, Germany.
Orthopedic Practice Clinic (OPPK), Muenster, Germany.
出版信息
Eur J Orthop Surg Traumatol. 2020 Jul;30(5):909-916. doi: 10.1007/s00590-020-02649-8. Epub 2020 Mar 11.
INTRODUCTION
Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures (PHFs) in the elderly. This study evaluates the influence of tuberosity healing (TH) on functional outcome following a 135° humeral inclination RSA for PHFs.
METHODS
Retrospectively, all patients with an acute PHF treated with a 135° humeral inclination RSA at four centers during a three-year period were followed up. Constant score (CS), TH and glenoid notching were analyzed.
RESULTS
Sixty-four of 100 patients (64%) with a mean age of 76 ± 7 years were available for follow-up at 22 ± 8 months. The mean-adjusted CS was 72%. TH of the greater tuberosity (GT) was 77% and resulted in significantly improved forward flexion (128° vs. 92°; p = 0.003), external rotation (33° vs. 17°; p = 0.03) and adjusted CS (78% vs. 54%, p < 0.005). GT healing rate was 86% with neutral, 70% with lateralized and 33% with an inferior eccentric glenosphere. TH of the lesser tuberosity was 79%. There was 8% complication and 3% revision rate; implant survival was 100%.
CONCLUSION
RSA with 135° humeral inclination for PHFs leads to good functional outcome, reproducible results and a high rate of TH. The short-term revision rate is low. TH is associated with improved ROM and functional outcome.
LEVEL OF EVIDENCE
III.
简介
反肩置换术（RSA）是治疗老年人肱骨近端骨折（PHF）的常用方法。本研究评估了在肱骨倾斜 135° RSA 治疗 PHF 中，肩峰下愈合（TH）对功能结果的影响。
方法
回顾性分析了在 3 年期间，4 个中心采用肱骨倾斜 135° RSA 治疗的 100 例急性 PHF 患者，随访了 64 例（64%）患者，平均年龄为 76±7 岁，随访时间为 22±8 个月。对 Constant 评分（CS）、TH 和肩胛盂切迹进行了分析。
结果
64 例患者中，有 64 例（64%）患者在 22±8 个月时接受了随访。平均调整后的 CS 为 72%。大结节（GT）TH 为 77%，显著改善了前屈（128° vs. 92°；p=0.003）、外旋（33° vs. 17°；p=0.03）和调整后的 CS（78% vs. 54%，p<0.005）。GT 愈合率为中性 86%、外侧化 70%、偏心下侧化 33%。小结节（LT）TH 为 79%。并发症发生率为 8%，翻修率为 3%；植入物存活率为 100%。
结论
对于 PHF，采用肱骨倾斜 135° RSA 可获得良好的功能结果、可重复的结果和较高的 TH 率。短期翻修率较低。TH 与 ROM 和功能结果的改善有关。
证据水平
III。
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