Department of Orthopedic Surgery, OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA.
Department of Orthopedic Trauma, OhioHealth/Grant Medical Center, Columbus, OH, USA.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4663-4669. doi: 10.1007/s00402-022-04746-1. Epub 2023 Jan 4.
Reverse shoulder arthroplasty (RSA) is a common treatment for three- and four-part proximal humerus fractures. RSA is commonly performed through a deltopectoral (DP) surgical approach; however, a deltoid split (DS) approach has been described. The purpose of this study was to compare the intraoperative and postoperative outcomes of patients undergoing RSA for proximal humerus fractures through a DP and DS approach.
A retrospective study of patients who underwent RSA for proximal humerus fractures at our level 1 trauma center was performed. Patients were evaluated at a minimum 1-year follow-up. Intraoperative outcomes as well as patient-reported outcome measures (PROMs) were analyzed. Postoperative complications, reoperation rates, and radiographic outcomes were evaluated.
Sixteen patients were included in the DP group and 13 patients in the DS group. The average follow-up was 28.6 months in the DP group and 21.1 months in the DS group. There were no significant differences in patient demographics or injury characteristics. Operative time was significantly shorter in the DS group (103 min) compared to the DP group (123 min). Tuberosity repair was performed in 81.3% of patients in the DP group and 92.3% of patients in the DS group. No significant differences were found in PROMs at final follow-up. There were no significant differences in postoperative complications. Three patients in the DP group and one patient in the DS group required reoperation. Lastly, 81.8% of patients achieved tuberosity union in the DS group and 66.7% in the DP group; however, this did not reach statistical significance.
This study demonstrates that RSA for proximal humerus fractures performed through a DS or DP approach may result in similar intraoperative and postoperative outcomes, with no difference in reoperation or complication rates.
反式肩关节置换术（RSA）是治疗三部分和四部分肱骨近端骨折的常用方法。 RSA 通常通过肩峰下肱二头肌长头腱前入路（DP）进行；然而，已经描述了三角肌劈开（DS）入路。本研究旨在比较 DP 和 DS 入路治疗肱骨近端骨折行 RSA 的术中及术后结果。
对我院 1 级创伤中心行 RSA 治疗肱骨近端骨折的患者进行回顾性研究。所有患者均接受至少 1 年随访。分析术中结果及患者报告的结果测量指标（PROMs）。评估术后并发症、再次手术率和影像学结果。
DP 组纳入 16 例患者，DS 组纳入 13 例患者。DP 组平均随访 28.6 个月，DS 组平均随访 21.1 个月。两组患者的人口统计学和损伤特征无显著差异。DS 组的手术时间（103 分钟）明显短于 DP 组（123 分钟）。DP 组 81.3%的患者和 DS 组 92.3%的患者行肩袖修复。最终随访时两组 PROMs 无显著差异。两组术后并发症无显著差异。DP 组 3 例患者和 DS 组 1 例患者需要再次手术。最后，DS 组 81.8%的患者和 DP 组 66.7%的患者达到肩袖结节愈合；但差异无统计学意义。
本研究表明，通过 DS 或 DP 入路行 RSA 治疗肱骨近端骨折可能获得相似的术中及术后结果，再次手术率和并发症率无差异。
