Department of Orthopaedics, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1581-1589. doi: 10.1007/s00590-022-03313-z. Epub 2022 Jun 27.
Following proximal humeral fractures hemiarthroplasty (HA) or reversed total shoulder arthroplasty (rTSA) are performed if osteosynthesis or conservative treatment is not possible. HA has been reported to result in decreased functional outcomes compared with rTSA. Secondary shoulder arthroplasty, performed after a different initial treatment, has also been associated with inferior outcomes.
Patients recieving a shoulder arthroplasty related to a proximal humeral fracture from 2010 to 2019 were included. A retrospective analysis of functional outcomes was performed using QuickDASH and subjective shoulder value (SSV).
The mean [standard deviation (SD)] follow-up time among the 82 included patients was 48 (28) months. The mean age was 70 (10) years. The mean age for HA was significantly different from rTSA [57 (9) and 72 (21) years; p < .001]. The mean QuickDASH score for primary arthroplasty was 11 (2) versus 12 (16) for secondary arthroplasty (p = .313). The mean SSV for primary arthroplasty was 84 (22) versus 82 (17) for secondary arthroplasty (p = .578). The mean QuickDASH score for HA was 24 (36) versus 9 (15) for rTSA (p = .346). The mean SSV for HA was 70 (34) versus 86 (17) for rTSA (p = .578).
Functional outcomes after fracture-related shoulder arthroplasty were excellent in an older population, even when performed secondarily after failed primary osteosynthesis or conservative treatment. No significant differences in shoulder function were identified between rTSA and HA, likely due to restrictive indications for HA.
如果内固定或保守治疗不可行，将进行肱骨头近端骨折半髋关节置换术（HA）或反式全肩关节置换术（rTSA）。与 rTSA 相比，HA 已被报道导致功能结果降低。在初次治疗不同的情况下进行二次肩关节置换术也与较差的结果相关。
纳入 2010 年至 2019 年接受与肱骨头近端骨折相关的肩关节置换术的患者。使用 QuickDASH 和主观肩部值（SSV）对功能结果进行回顾性分析。
在 82 名纳入的患者中，平均（标准差）随访时间为 48（28）个月。平均年龄为 70（10）岁。HA 的平均年龄明显不同于 rTSA [57（9）和 72（21）岁；p < .001]。初次关节置换的平均 QuickDASH 评分为 11（2），二次关节置换的平均 QuickDASH 评分为 12（16）（p = .313）。初次关节置换的平均 SSV 为 84（22），二次关节置换的平均 SSV 为 82（17）（p = .578）。HA 的平均 QuickDASH 评分为 24（36），rTSA 的平均 QuickDASH 评分为 9（15）（p = .346）。HA 的平均 SSV 为 70（34），rTSA 的平均 SSV 为 86（17）（p = .578）。
在老年人群中，即使在初次内固定或保守治疗失败后进行二次治疗，与骨折相关的肩关节置换术后的功能结果也非常出色。rTSA 和 HA 之间的肩部功能没有显著差异，这可能是由于 HA 的适应证受到限制。
