骨水泥型与非骨水泥型反向全肩关节置换术治疗老年肱骨近端骨折的回顾性病例对照研究。
Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly-a retrospective case-control study.
机构信息
Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
出版信息
BMC Musculoskelet Disord. 2022 Dec 1;23(1):1043. doi: 10.1186/s12891-022-05994-3.
BACKGROUND
Uncemented reverse total shoulder arthroplasty (RTSA) for the primary treatment of proximal humerus fractures (PHF) in elderly patients was introduced at our institution in 2017. Recent reports have raised concerns about increased rates of early bone resorption at the proximal humerus with uncemented fracture stems. The aim of this study was to find out whether there was any difference in functional or radiographic outcomes between cemented and uncemented RTSA for PHF.
METHODS
Seventeen consecutive patients who underwent uncemented RTSA (group nC) in 2017 and 2018 were age and sex matched (propensity score matching 1:2) to 34 patients with cemented RTSA implanted between 2011 and 2016 (group C) for the primary treatment of PHF. These two groups were compared in terms of clinical and radiographic outcomes at 2 years after the index surgery.
RESULTS
The mean bone quality was low in both groups: in group nC the deltoid tuberosity index (DTI) was 1.43 (1.22-1.72) and in group C 1.42 (1.22-1.67). At the final 2 year follow-up, the relative CS was 98.3% (71-118) in group nC and 97.9% (36-125) in group C (p = 0.927); the absolute CS was 70.2 (49-89) in group nC and 68.0 (30-94) in group C (p = 0.509). Lucent lines at the humeral site were seen in 8 cases (47%) in group nC and in 13 cases (38%) in group C (p = 0.056). Compared to 3% in group C, all patients in group nC showed at least grade 1 and 65% showed grade 3 bone resorption at the proximal humerus (p < 0.001).
CONCLUSION
Compared to cemented RTSA bone resorption at the proximal humerus was significantly more frequent in patients with uncemented RTSA for PHF. So far, this is rather a radiographic than a clinical finding, because both groups showed very satisfying functional outcomes and low revision rates at the 2 year follow-up.
LEVEL OF EVIDENCE III
A retrospective case-control study.
背景
我院自 2017 年开始将非骨水泥型反式全肩关节置换术（RTSA）用于治疗老年患者的肱骨近端骨折（PHF）。最近的报告显示，非骨水泥型骨折柄在肱骨近端的早期骨吸收发生率较高。本研究旨在探讨 PHF 采用骨水泥型和非骨水泥型 RTSA 的功能和影像学结果是否存在差异。
方法
将 2017 年和 2018 年接受非骨水泥型 RTSA（nC 组）的 17 例连续患者与 2011 年至 2016 年间接受骨水泥型 RTSA（C 组）的 34 例患者进行年龄和性别匹配（倾向评分匹配 1:2），以治疗 PHF。比较两组患者在索引手术后 2 年的临床和影像学结果。
结果
两组的平均骨质量均较低：nC 组三角肌结节指数（DTI）为 1.43（1.22-1.72），C 组为 1.42（1.22-1.67）。在最终的 2 年随访时，nC 组的相对 CS 为 98.3%（71-118），C 组为 97.9%（36-125）（p=0.927）；nC 组的绝对 CS 为 70.2（49-89），C 组为 68.0（30-94）（p=0.509）。nC 组有 8 例（47%）和 C 组有 13 例（38%）出现肱骨部位透亮线（p=0.056）。与 C 组的 3%相比，nC 组所有患者均至少出现 1 级骨吸收，65%的患者出现 3 级肱骨近端骨吸收（p<0.001）。
结论
与骨水泥型 RTSA 相比，PHF 患者采用非骨水泥型 RTSA 时，肱骨近端的骨吸收明显更为常见。到目前为止，这主要是一种影像学发现，而不是临床发现，因为两组在 2 年随访时均表现出非常满意的功能结果和较低的翻修率。
证据等级 III：回顾性病例对照研究。
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