Orthopädie Sonnenhof, Buchserstrasse 4, 3006, Bern, Switzerland.
Int Orthop. 2020 Dec;44(12):2673-2681. doi: 10.1007/s00264-020-04813-5. Epub 2020 Sep 29.
Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature.
We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group.
Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor.
Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
反式全肩关节置换术后肩峰和肩胛脊柱骨折是严重的并发症。它们约占患者的 4 至 5%，并且总是导致肩部功能显著恶化。已经考虑了不同的原因，特别是应力或疲劳骨折。本研究的目的是分析我们自己的病例，并讨论文献中报道的原因。
我们回顾了我们的肩关节置换登记处和过去十年的咨询报告。仔细检查了所有术后发生肩峰或肩胛脊柱骨折的患者的图表和 X 光片，并将结果与年龄和性别匹配的对照组进行了比较。
12 名平均年龄为 79 岁的患者发生肩峰（n=6）或肩胛脊柱（n=6）骨折。手术和骨折之间的时间间隔平均为 26 个月，范围从 3 周到 70 个月。8 名患者（67%）有创伤史。其中 7 人报告在相应的肩部跌倒，1 人在肩峰上受到重击。4 例非创伤性骨折归因于骨质量差。所有 12 名患者均立即出现疼痛，并难以主动抬起受影响的手臂。骨折和诊断之间的时间间隔平均为 10 周（0 至 10 个月）。最终随访时，所有患者均能触及面部并拒绝进一步手术。2 名患者的结果评为良好，6 名患者评为可接受，4 名患者评为差。
我们的研究不能支持反式全肩关节置换术后肩峰和肩胛脊柱骨折大多数是三角肌张力增加或应力骨折的结果的假说。在我们的系列中，大多数骨折与跌倒有关。反向假体的植入使肩峰更容易受到直接创伤。非创伤性骨折与骨质量差有关。
