Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Department of Orthopedic Surgery, Cantonal Hospital Lucerne, Sursee, Switzerland.
Int Orthop. 2020 Dec;44(12):2711-2717. doi: 10.1007/s00264-020-04831-3. Epub 2020 Oct 15.
The use of reverse shoulder arthroplasty (RSA) to treat complex humerus fractures is increasing, especially in older, osteoporotic patients. Refixation and tuberosity healing are needed to achieve an optimal range of motion (ROM), external rotation, active forward elevation, and patient satisfaction. Proper healing has been reported, however, in only 40-84% of cases. Our study's aim was to describe a simple, reproducible fixation technique designed to improve tuberosity healing.
We included 30 patients with acute proximal humerus fractures undergoing RSA (Global Unite Reverse Fracture, DePuy Synthes, Warsaw, IN, USA) with tuberosity reattachment. The humerus stem was cemented in 24 cases. A standardized suture technique with two fiber tapes was used to reattach tuberosities. Clinical and radiological parameters, which were collected one year post-operatively, included ROM, pain level, Constant scores, subjective shoulder value (SSV), and tuberosity healing.
The mean age of the patients was 79.3 years (± 7; range 65-92), and the tuberosity healing rate was 90.0% (27 of 30). Two patients showed migration (one nonunion, one malunion), and another had complete resorption after an initial period of proper healing. Radiolucent lines around the humerus stem occurred in one case, and three patients had scapular notching. The mean SSV was 86% (± 11; range 60-100), the Constant score was 72 (± 10.3; range 48-92), the active forward flexion was 140° (± 14.3; range 115-165), and external rotation was 23° (± 16.5; range 0-50).
This reattachment technique, which is simple and reproducible, achieved a higher tuberosity healing rate than previously published rates.
使用反肩置换术（RSA）治疗复杂肱骨骨折的情况越来越多，尤其是在老年骨质疏松患者中。为了实现理想的活动范围（ROM）、外旋、主动前屈和患者满意度，需要重新固定和修复结节。尽管已有报道称已愈合，但仅在 40-84%的病例中。我们的研究旨在描述一种简单、可重复的固定技术，旨在提高结节愈合率。
我们纳入了 30 例接受 RSA（全球联合反骨折，Depuy Synthes，华沙，IN，美国）治疗伴结节再附着的急性肱骨近端骨折的患者。在 24 例中，肱骨柄用水泥固定。使用带有两根纤维带的标准化缝合技术重新附着结节。术后一年收集临床和影像学参数，包括 ROM、疼痛程度、Constant 评分、主观肩部值（SSV）和结节愈合。
患者的平均年龄为 79.3 岁（±7；范围 65-92），结节愈合率为 90.0%（27/30）。两名患者出现移位（1 例为骨不连，1 例为畸形愈合），另一名患者在最初愈合后完全吸收。1 例出现肱骨柄周围透光线，3 例出现肩胛切迹。平均 SSV 为 86%（±11；范围 60-100），Constant 评分为 72（±10.3；范围 48-92），主动前屈为 140°（±14.3；范围 115-165），外旋为 23°（±16.5；范围 0-50）。
与先前发表的报告相比，这种简单且可重复的再附着技术提高了结节愈合率。
