Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
J Shoulder Elbow Surg. 2022 Jun;31(6):1143-1153. doi: 10.1016/j.jse.2021.11.012. Epub 2021 Dec 27.
Acromial and scapular spine fractures (ASFs) are known complications following implantation of reverse total shoulder arthroplasty (RTSA). The entity of acromial stress reaction (ASR) without fracture has recently been described. The purpose of this study was to analyze the incidence, radiographic predictors, treatment options, healing rates, and clinical outcomes of ASF and ASR compared with a control group.
A total of 854 primary RTSAs were implanted between 2005 and 2018 in a single shoulder unit of a tertiary referral hospital and retrospectively reviewed for the incidence of ASF and ASR. ASR was defined as pain at the acromion or scapular spine after fracture exclusion on computed tomography scans. The ASF group was matched to a control group. Preoperative and postoperative radiographs were analyzed for radiographic predictors of ASF or ASR. The impact of ASF and ASR, operative vs. nonoperative treatment, and fracture union on clinical outcomes (Constant-Murley score [CS], Subjective Shoulder Value [SSV], and range of motion) with a minimum follow-up period of 2 years was analyzed.
A total of 46 ASFs (5.4%) in 44 patients and 44 ASRs (5.2%) in 43 patients were detected at a mean of 16 ± 24 months and 20 ± 23 months postoperatively, respectively. Predictive radiographic factors were an increased critical shoulder angle and lateralization shoulder angle. The overall union rate was 55% (22 of 40) but was significantly higher following operative treatment (9 of 11, 82%) compared with nonoperative treatment (13 of 29, 45%). Patients with ASF or ASR demonstrated inferior clinical outcomes (CS, 44 ± 21 and 48 ± 18; SSV, 52% ± 25% and 57% ± 27%) compared with the control group (CS, 66 ± 14; SSV, 82% ± 22%) independent of bony union or treatment at a mean of 59 ± 33 months (ASF) and 61 ± 38 months (ASR).
ASF and ASR are frequent complications following RTSA implantation with similar poor clinical outcome measures. The healing rate was shown to be much higher with a surgical approach. Nevertheless, fracture consolidation does not result in better clinical outcomes compared with nonunion.
肩峰和肩胛脊柱骨折（ASFs）是反式全肩关节置换术（RTSA）植入后的已知并发症。最近已经描述了没有骨折的肩峰应力反应（ASR）实体。本研究的目的是分析与对照组相比，ASF 和 ASR 的发生率、影像学预测因素、治疗选择、愈合率和临床结果。
对 2005 年至 2018 年间在一家三级转诊医院的一个单肩单位植入的 854 例原发性 RTSA 进行回顾性分析，以确定 ASF 和 ASR 的发生率。ASR 定义为在排除 CT 扫描骨折后，肩峰或肩胛脊柱处疼痛。ASF 组与对照组相匹配。分析术前和术后 X 线片以确定 ASF 或 ASR 的影像学预测因素。分析 ASF 和 ASR、手术与非手术治疗以及骨折愈合对临床结果（Constant-Murley 评分[CS]、主观肩部值[SSV]和运动范围）的影响，随访时间至少为 2 年。
术后平均 16±24 个月和 20±23 个月时，分别在 44 例患者的 46 例 ASF（5.4%）和 43 例患者的 44 例 ASR（5.2%）中发现。预测性影像学因素是临界肩角和外侧肩角增加。总体愈合率为 55%（22/40），但手术治疗（9/11，82%）明显高于非手术治疗（13/29，45%）。与对照组（CS，66±14；SSV，82%±22%）相比，ASF 或 ASR 患者的临床结果（CS，44±21 和 48±18；SSV，52%±25%和 57%±27%）较差，无论是否存在骨愈合或治疗，平均随访时间为 59±33 个月（ASF）和 61±38 个月（ASR）。
ASF 和 ASR 是 RTSA 植入后的常见并发症，临床结果指标相似较差。手术方法显示愈合率更高。然而，与非愈合相比，骨折愈合并不能带来更好的临床结果。
