Department of Orthopaedic Surgery and Sport Traumatology, Grenoble North University Hospital, 38700 La Tronche, France.
Department of Orthopaedic Surgery and Sport Traumatology, Hospital Center Metropole Savoie, 73000 Chambéry, France.
Orthop Traumatol Surg Res. 2020 Oct;106(6):1113-1118. doi: 10.1016/j.otsr.2020.04.018. Epub 2020 Aug 14.
Reverse shoulder arthroplasty (RSA) has become a common treatment in displaced proximal humeral fracture (PHF) in elderly patients due to inconstant results with osteosynthesis or hemiarthroplasty. RSA allows a good anterior elevation but rotational results are more random and depend on tuberosity healing.
Use of an offset modular system (OMS) on the prothesis improve tuberosity healing and functional results.
This retrospective cohort analysed radiological and clinical outcomes at least one year after the use of RSA Humelock II Reversed (Fx Solutions) after a displaced PHF Neer 3 or 4 in patients over 70 years. The first criterion was tuberosity healing with or without the use of the OMS device on radiographs. The second criterion was a clinical analysis of active range of motion (ROM), anterior elevation (AAE), external and internal rotations (ER, IR), Constant, DASH, SSV, VAS scores according to tuberosity healing. We also analysed radiological and clinical complications.
We analysed from November 2013 to May 2018 thirty-four RSA. Mean age was 78±5,7 years, mean follow up was 18±7,2 months and the mean tuberosity healing rate was 79%. Mean ROM were: 117±24 (AAE), 18̊±18 (ER) and L2 (IR). On the first analysis, healing tuberosity with cage was present on 24 (92%) patients versus 3 (37,5%) without (p<0,005). The second analysis showed a non-significant improvement on ER, IR, Constant, DASH and SSV. Complications found were three removal of prothesis after infection, one axillary nerve lesion, one ulnar paraesthesia and one humeral loosening.
The use of the OMS cage allows a better consolidation of tuberosities in a significant way but no significant clinical effects was highlighted due to a small patient number in the study.
level III, retrospective cohort.
由于内固定或半肩关节成形术的结果不稳定，反肩置换术 (RSA) 已成为老年移位性肱骨近端骨折 (PHF) 的常见治疗方法。RSA 可以实现良好的前向抬高，但旋转结果更随机，取决于肩峰愈合情况。
假体上使用偏心模块系统 (OMS) 可改善肩峰愈合和功能结果。
这项回顾性队列研究分析了至少在 70 岁以上患者因移位性 Neer 3 或 4 PHF 行 RSA Humelock II 反向 (Fx 解决方案) 后一年以上使用 RSA 的放射学和临床结果。第一个标准是有无使用 OMS 装置的肩峰愈合情况。第二个标准是根据肩峰愈合情况对主动活动范围 (ROM)、前向抬高 (AAE)、外旋和内旋 (ER、IR)、Constant、DASH、SSV、VAS 评分进行临床分析。我们还分析了放射学和临床并发症。
我们分析了 2013 年 11 月至 2018 年 5 月的 34 例 RSA。平均年龄为 78±5.7 岁，平均随访时间为 18±7.2 个月，平均肩峰愈合率为 79%。平均 ROM 为：117±24（AAE）、18°±18（ER）和 L2（IR）。第一次分析显示，有笼的肩峰愈合率为 24 例（92%），无笼的为 3 例（37.5%）（p<0.005）。第二次分析显示，ER、IR、Constant、DASH 和 SSV 无显著改善。发现的并发症有 3 例感染后假体取出、1 例腋神经损伤、1 例尺神经感觉异常和 1 例肱骨松动。
使用 OMS 笼可以显著改善肩峰的固定，但由于研究中患者数量较少，未发现明显的临床效果。
III 级，回顾性队列。
