AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria.
Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
BMC Musculoskelet Disord. 2021 Jan 8;22(1):48. doi: 10.1186/s12891-020-03903-0.
The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).
This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals).
Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.
RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.
Level III.
反向全肩关节置换术（RSA）作为一种治疗复杂肱骨近端骨折的选择，极大地扩展了手术手段。本研究旨在探讨急性或后遗症及挽救性手术中 RSA 骨折的中期结果。假设翻修 RSA（SRSA）与 RSA 治疗原发性骨折（PRSA）的中期结果相似。
这项回顾性研究采用标准化的单中心和嵌入式设计，描述了放射学和临床中期结果。纳入了 2008 年至 2017 年期间在骨折治疗中接受 RSA 的患者（最低随访时间：2 年，最低年龄：60 岁）。用于功能发现的评估工具包括活动范围（ROM）、视觉模拟量表、绝对（CS）加正常常数评分、快速残疾指数和主观肩部值。所有不良事件以及放射学结果及其临床相关性均进行了统计学分析（使用 p <.05 和 95%置信区间）。
RSA 治疗骨折后，纳入 68 例患者（平均年龄：72.5 岁，平均随访：46 个月）。42 例行原发性 RSA（PRSA），26 例行翻修 RSA（SRSA）。13%（9/68）发生不良事件。PRSA 和 SRSA 组的评分无统计学差异，而 SRSA 组的骨折固定失败亚组在 ROM 亚区的评分有统计学意义的负值（屈曲：p =.020，外展：p =.020）。PRSA 组较 SRSA 组结节愈合的发生率降低（p =.006）。结节骨不愈合与显著的阴性临床和主观结果相关（所有评分：p <.05，外旋：p=.019）。SRSA 组术后改善明显（CS：平均 23 至 56，p =.001），从指数手术到手术修正的时间与功能发现无关。
RSA 是一种治疗严重肩部骨折的有效方法，挽救性治疗和一线治疗的结果均具有可预测性。可获得有前景的中期功能结果、合理的植入物存活率和高患者满意度。
III 级。
