Paszicsnyek Alexander, Kriechling Philipp, Razaeian Sam, Ernstbrunner Lukas, Wieser Karl, Borbas Paul
Department of Orthopaedic Surgery and Traumatology, General Hospital Oberndorf, Paracelsusstraße 37, 5110 Oberndorf, Austria.
Department of Orthopedics, Balgrist University Hospital, 8008 Zürich, Switzerland.
J Clin Med. 2023 Mar 7;12(6):2097. doi: 10.3390/jcm12062097.
With the increase in utility and popularity of the reverse total shoulder arthroplasty (RTSA) within the last decades, indications for RTSA have expanded. As well as the established indications such as cuff tear arthropathy and massive irreparable rotator cuff tears, RTSA for complex proximal humeral fractures in elderly patients has been proven to be a reliable treatment option.
A prospectively enrolled RTSA database of 1457 RTSAs implanted between September 2005 and November 2020 was reviewed. Patients treated with RTSA for a complex proximal humerus fracture and fracture sequalae (F-RTSA) were 1:1 matched with a group of patients who were treated electively with RTSA for indications other than a fracture (E-RTSA). Matching criteria included sex, age, length of follow-up and body mass index. Evaluation after a minimum of 2 years follow-up included evaluation of the absolute and relative Constant-Murley score (aCS; rCS), subjective shoulder value (SSV), range of motion (ROM) assessment and complications.
Each of the matched cohorts comprised 134 patients with a mean follow-up of 58 ± 41 months for the fracture group and 58 ± 36 months for the elective group. The mean age for both groups was 69 ± 11 years in the F-RTSA and 70 ± 9 years for the E-RTSA group. There were no significant differences in clinical outcome measures including aCS, rCS and SSV ( > 0.05). There was a significant difference in mean active external rotation with 20° ± 18° in the F-RTSA group compared with 25° ± 19° in the E-RTSA group ( = 0.017). The complication rate was not significantly different, with 41 complications in 36 shoulders in the F-RTSA and 40 complications in 32 shoulders in the E-RTSA group ( = 0.73). The main complication for the F-RTSA group was dislocation of the greater tuberosity (6%), whereas acromial fractures (9%) were the leading complication in the E-RTSA group. There was also no significant difference in revision rate comparing F-RTSA with E-RTSA (10% vs. 14%; = 0.25).
RTSA for complex proximal humeral fractures and its sequalae leads to a comparable clinical outcome as that for patients treated electively with RTSA for indications other than fracture. There was, however, a significant difference in active external rotation, with inferior rotation in patients undergoing RTSA for fracture. This valuable information can help in requesting informed consent of patients with proximal humeral fractures.
在过去几十年中，随着反式全肩关节置换术（RTSA）的实用性和普及性不断提高，其适应证也有所扩大。除了诸如肩袖撕裂性关节病和巨大不可修复的肩袖撕裂等既定适应证外，RTSA治疗老年患者复杂的肱骨近端骨折已被证明是一种可靠的治疗选择。
回顾了一个前瞻性纳入的RTSA数据库，该数据库包含2005年9月至2020年11月期间植入的1457例RTSA。接受RTSA治疗复杂肱骨近端骨折及骨折后遗症（F-RTSA）的患者与一组因非骨折适应证而接受选择性RTSA治疗的患者（E-RTSA）进行1:1匹配。匹配标准包括性别、年龄、随访时间和体重指数。至少随访2年后的评估包括绝对和相对Constant-Murley评分（aCS；rCS）、主观肩关节评分（SSV）、活动范围（ROM）评估和并发症评估。
每个匹配队列包括134例患者，骨折组平均随访58±41个月，择期组平均随访58±36个月。F-RTSA组和E-RTSA组的平均年龄分别为69±11岁和70±9岁。包括aCS、rCS和SSV在内的临床结局指标无显著差异（>0.05）。F-RTSA组平均主动外旋角度为20°±18°，E-RTSA组为25°±19°，两组间存在显著差异（P=0.017）。并发症发生率无显著差异，F-RTSA组36例肩部出现41例并发症，E-RTSA组32例肩部出现40例并发症（P=0.73）。F-RTSA组的主要并发症是大结节脱位（6%），而肩峰骨折（9%）是E-RTSA组的主要并发症。F-RTSA组与E-RTSA组的翻修率也无显著差异（10%对14%；P=0.25）。
RTSA治疗复杂肱骨近端骨折及其后遗症的临床结局与因非骨折适应证而接受选择性RTSA治疗的患者相当。然而，主动外旋存在显著差异，接受RTSA治疗骨折的患者外旋较差。这些有价值的信息有助于获得肱骨近端骨折患者的知情同意。
