反式肩关节置换术治疗肱骨近端骨折优于非手术治疗：一项匹配队列分析。
Superior Outcomes With Reverse Shoulder Arthroplasty versus Nonoperative Management for Proximal Humerus Fractures: A Matched Cohort Analysis.
机构信息
Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY; and.
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
出版信息
J Orthop Trauma. 2023 Jun 1;37(6):e247-e252. doi: 10.1097/BOT.0000000000002559.
OBJECTIVE
To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA).
DESIGN
Retrospective cohort.
SETTING
Academic level 1 trauma center, level 2 trauma/geriatric fracture center.
PATIENTS/INTERVENTION: Seventy-one patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology.
MAIN OUTCOME MEASUREMENTS
Patient-reported outcomes, range of motion, and complications rates within 1 year of treatment.
RESULTS
RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared with nonoperative patients throughout the first 6 months after treatment ( P < 0.05 for all). RSA patients achieved satisfactory ROM (>90 degrees aFF) at higher rates than nonoperative patients (96.2% vs. 62.2%, P < 0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment ( P < 0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared with the nonoperative group ( P < 0.05 for all). Similar complication rates were experienced in both groups (nonoperative = 8.9%, RSA = 7.7%; P = 0.36).
CONCLUSIONS
In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared with nonoperative management, without significant differences in short-term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
评估老年肱骨近端骨折经非手术或反肩关节置换术（RSA）治疗的早期结果（1 年内）。
设计
回顾性队列研究。
地点
学术 1 级创伤中心，2 级创伤/老年骨折中心。
患者/干预措施：71 例肱骨近端骨折患者，行非手术治疗或 RSA 治疗，按年龄、合并症负担和骨折形态匹配。
主要观察指标
治疗后 1 年内患者报告的结果、活动范围和并发症发生率。
结果
与非手术组相比，RSA 组患者在治疗后前 6 个月的主动前屈（aFF）和外旋角度更大（所有 P < 0.05）。RSA 组患者达到满意的 ROM（>90°aFF）的比例高于非手术组（96.2%比 62.2%，P < 0.01）。RSA 在治疗后 1 年内显著降低了肩部疼痛和 PROMIS 疼痛干扰评分（所有 P < 0.05）。与非手术组相比，RSA 组在治疗后 3 个月、6 个月和 1 年的 PROMIS 躯体功能评分也更高（所有 P < 0.05）。两组的并发症发生率相似（非手术组 8.9%，RSA 组 7.7%；P = 0.36）。
结论
在年龄、合并症和骨折形态匹配分析中，与非手术治疗相比，RSA 治疗肱骨近端骨折在治疗的前 6 个月内与更大的肩部 ROM、减轻疼痛和改善躯体功能相关，且短期并发症无显著差异。这些结果表明，在肱骨近端骨折的早期恢复期间，RSA 可能优于非手术治疗。
证据水平
治疗性 III 级。欲了解完整的证据等级说明，请参见作者须知。
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