Wixted Colleen M, Goltz Daniel E, Wickman John R, Levin Jay M, Lassiter Tally, Klifto Christopher, Anakwenze Oke
Duke University School of Medicine, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
JSES Int. 2021 Sep 14;5(6):1021-1026. doi: 10.1016/j.jseint.2021.07.013. eCollection 2021 Nov.
The incidence of shoulder arthroplasty in the United States continues to increase, and while the risk of intraoperative complications such as fracture remains relatively low, there has been little investigation into whether certain patient-specific risk factors predispose to this complication. This study characterizes the incidence of intraoperative fracture during shoulder arthroplasty and additionally hypothesizes that certain risk factors may exist in addition to potentially leading to worsened near-term outcomes.
An institutional database of shoulder arthroplasties (N = 1773; 994 anatomic, 779 reverse) was retrospectively reviewed, and the operative reports for each case were examined for documentation of an intraoperative fracture, including during which surgical step the fracture took place. Various preoperative and intraoperative factors were tested for comparative significance ( < .05) using chi-square and Kruskal-Wallis tests as appropriate. Length of stay, 90-day readmission, and discharge to rehabilitation or skilled nursing facility (SNF) were further examined as secondary outcomes.
Twenty-one (1.2%) intraoperative fractures were documented, a majority of which occurred in reverse shoulder arthroplasties compared to anatomic procedures (overall incidence: 2.5% vs. 0.2%, < .001). These most commonly occurred during either stem broaching (33%) or seating (33%) and were most likely to involve the metaphysis (53%) or greater tuberosity (33%). Five fractures occurred during revision arthroplasty, while 16 fractures occurred during primary procedures (overall incidence: 3.0 vs. 1.0%, = .03). Patient factors reaching statistical significance included female gender and liver disease, while age and smoking history were notably not associated with intraoperative fracture. The fracture cohort had a significantly longer mean length of stay (2.42 vs. 2.17 days, < .001). While the rates of 90-day readmission and discharge to SNF/rehab were higher in the fracture cohort, these values did not reach statistical significance.
Intraoperative fractures are a rare complication (1.2%) in shoulder arthroplasty, with reverse shoulder arthroplasty, revision cases, and female gender associated with an elevated overall risk. While these patients had a longer inpatient hospitalization, the substantially higher rates of 90-day readmission and discharge to SNF/rehab did not reach significance in our limited institutional cohort. The aforementioned incidence and risk factors serve as crucial evidence for use during the preoperative counseling process with patients as part of a shared decision-making model.
在美国，肩关节置换术的发病率持续上升，虽然术中骨折等并发症的风险相对较低，但对于某些特定患者的风险因素是否易引发该并发症，几乎没有相关研究。本研究对肩关节置换术中术中骨折的发生率进行了描述，并进一步假设除了可能导致近期预后恶化外，还可能存在某些风险因素。
回顾性分析了一个机构的肩关节置换术数据库（N = 1773；994例解剖型，779例反置型），并检查了每个病例的手术报告，以记录术中骨折情况，包括骨折发生在哪个手术步骤。使用卡方检验和Kruskal-Wallis检验对各种术前和术中因素进行比较显著性检验（P <.05）。将住院时间、90天再入院率以及出院后转至康复机构或熟练护理机构（SNF）的情况作为次要结果进一步分析。
记录到21例（1.2%）术中骨折，其中大部分发生在反置肩关节置换术中，与解剖型手术相比（总体发生率：2.5%对0.2%，P <.001）。这些骨折最常发生在柄部扩髓（33%）或植入（33%）过程中，最常累及干骺端（53%）或大结节（33%）。5例骨折发生在翻修置换术中，16例骨折发生在初次手术中（总体发生率：3.0%对1.0%，P =.03）。具有统计学意义的患者因素包括女性性别和肝病，而年龄和吸烟史与术中骨折明显无关。骨折组的平均住院时间显著更长（2.42天对2.17天，P <.001）。虽然骨折组的90天再入院率和出院后转至SNF/康复机构的比例较高，但这些数值未达到统计学意义。
术中骨折是肩关节置换术中一种罕见的并发症（1.2%），反置肩关节置换术、翻修病例以及女性性别与总体风险升高相关。虽然这些患者的住院时间较长，但在我们有限的机构队列中，90天再入院率和出院后转至SNF/康复机构的比例大幅升高并未达到显著水平。上述发生率和风险因素是术前与患者进行咨询过程中的关键证据，作为共同决策模型的一部分。
