Viswanathan Shashidharan, Kashyap Anjali Hema, Shanker Harish Kashyap
Trauma and Orthopedics, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Paisley, GBR.
Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Health Campus, Aberdeen, GBR.
Cureus. 2023 Feb 5;15(2):e34652. doi: 10.7759/cureus.34652. eCollection 2023 Feb.
Introduction Reverse shoulder arthroplasty (RSA) is becoming increasingly popular as a primary procedure for complex proximal humeral fractures (PHF) in acute trauma due to more emerging evidence and better patient outcomes. Methods This study is a retrospective case series of 51 patients who underwent a trabecular metal RSA for non-reconstructable, acute three or four-part PHF performed by a single surgeon between 2013 and 2019 with a minimum follow-up of three years. This included 44 females and seven males. Mean age was 76 years (range: 61-91 years). Oxford shoulder score (OSS) along with relevant patient information relating to demographics and functional outcomes were collected at regular intervals in outpatient clinic follow-ups. Complications were addressed accordingly during treatment and follow-up. Results The mean follow-up duration was 5.08 years. Two patients were lost to follow-up and nine patients died due to other causes. Four of them had developed severe dementia and were excluded as an outcome score from them could not be acquired. Two patients who had surgery beyond four weeks post-injury were excluded. Thirty-four patients in total were followed up. Patients had good range of motion and mean OSS of 40.28 post-operatively. The overall complication rate was 11.7%, and none of the patients had deep infections, scapular notching, or acromial fractures. Revision rate was 5.8% at mean follow-up of five years and one month (range: three years to nine years two months). Greater tuberosity union following intra-operative repair was evident on radiographs in 61.7% of the patients. Conclusion RSA is certainly a rewarding surgery in patients with complex PHF and was associated with good post-operative OSS along with patient satisfaction, and positive radiological outcomes at minimum three-year follow-up.
引言 随着越来越多新出现的证据以及更好的患者预后，反肩关节置换术（RSA）作为急性创伤中复杂肱骨近端骨折（PHF）的主要手术方法正变得越来越流行。
方法 本研究是一项回顾性病例系列研究，纳入了51例患者，这些患者在2013年至2019年间由同一外科医生进行了小梁金属RSA手术，用于治疗不可重建的急性三部分或四部分PHF，且随访时间至少为三年。其中包括44名女性和7名男性。平均年龄为76岁（范围：61 - 91岁）。在门诊随访中定期收集牛津肩部评分（OSS）以及与人口统计学和功能结局相关的患者信息。在治疗和随访期间对并发症进行相应处理。
结果 平均随访时间为5.08年。2例患者失访，9例患者因其他原因死亡。其中4例出现严重痴呆，由于无法获得其结局评分而被排除。2例受伤后超过四周进行手术的患者被排除。总共34例患者得到随访。患者术后活动范围良好，平均OSS为40.28。总体并发症发生率为11.7%，没有患者发生深部感染、肩胛切迹或肩峰骨折。在平均五年零一个月（范围：三年至九年零两个月）的随访中，翻修率为5.8%。61.7%的患者在术中修复后，X线片显示大结节愈合。
结论 对于复杂PHF患者，RSA无疑是一项值得的手术，在至少三年的随访中，其与良好的术后OSS、患者满意度以及积极的影像学结局相关。
