Zhao Yang, Zhu Yiming, Lu Yi, Li Fenglong, Jiang Chunyan
Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.
Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.
J Shoulder Elbow Surg. 2024 Jan;33(1):46-54. doi: 10.1016/j.jse.2023.05.017. Epub 2023 Jun 17.
Humeral head replacement (HHR) is now rarely recommended for complex proximal humeral fractures (PHFs) in older patients. However, in relatively young and active patients with unreconstructable complex PHFs, controversy still exists regarding the treatment options of reverse shoulder arthroplasty and HHR. The goal of this study was to compare the survival, functional, and radiographic outcomes of HHR in patients aged <70 years and those aged ≥70 years after a minimum 10 years follow-up.
Eighty-seven out of 135 patients undergoing primary HHR were enrolled and then divided into 2 groups based on age: <70 years and ≥70 years. Clinical and radiographic evaluations were performed with a minimum follow-up of 10 years.
There were 64 patients (mean, 54.9 years) in the younger group and 23 patients (mean, 73.5 years) in the older group. The younger and older groups had comparable 10-year implant survivorship (98.4% vs. 91.3%). Patients aged ≥70 years had worse American Shoulder and Elbow Surgeons scores (74.2 vs. 81.0, P = .042) and lower satisfaction rates (12% vs. 64%, P < .001) than younger patients. At the final follow-up, older patients had worse forward flexion (117° vs. 129°, P = .047) and internal rotation (17 vs. 15, P = .036). More greater tuberosity complications (39% vs. 16%, P = .019), glenoid erosion (100% vs. 59%, P = .077), and humeral head superior migration (80% vs. 31%, P = .037) were also identified in patients aged ≥70 years.
Unlike the increased risk for revision and functional deterioration over time after reverse shoulder arthroplasty for PHFs in younger patients, a high implant survival rate with lasting pain relief and stable functional outcomes could be observed in younger patients after HHR during long-term follow-up. Patients aged ≥70 years had worse clinical outcomes, lower patient satisfaction, more greater tuberosity complications, and more glenoid erosion and humeral head superior migration than those aged <70 years. HHR should not be recommended for the treatment of unreconstructable complex acute PHFs in older patient populations.
目前，对于老年患者的复杂肱骨近端骨折（PHF），很少推荐进行肱骨头置换术（HHR）。然而，对于相对年轻且活动较多的不可重建复杂PHF患者，在反肩关节置换术和HHR的治疗选择上仍存在争议。本研究的目的是比较年龄＜70岁和≥70岁患者行HHR术后至少10年随访的假体生存率、功能及影像学结果。
135例行初次HHR的患者中，87例被纳入研究，然后根据年龄分为两组：＜70岁组和≥70岁组。进行临床和影像学评估，随访时间至少10年。
较年轻组有64例患者（平均年龄54.9岁），较年长组有23例患者（平均年龄73.5岁）。较年轻组和较年长组的10年假体生存率相当（98.4%对91.3%）。≥70岁的患者美国肩肘外科医师评分较差（74.2对81.0，P = 0.042），满意度较低（12%对64%，P ＜0.001）。在末次随访时，年长患者的前屈（117°对129°，P = 0.047）和内旋（17对15，P = 0.036）较差。≥70岁的患者还出现更多的大结节并发症（39%对16%，P = 0.019）、盂骨侵蚀（100%对59%，P = 0.077）和肱骨头向上移位（80%对31%，P = 0.037）。
与年轻患者PHF行反肩关节置换术后随着时间推移翻修风险增加和功能恶化不同，年轻患者HHR术后长期随访可观察到较高的假体生存率、持续的疼痛缓解和稳定的功能结果。≥70岁的患者比＜70岁的患者临床结果更差、患者满意度更低、大结节并发症更多、盂骨侵蚀和肱骨头向上移位更多。不建议对老年患者群体的不可重建复杂急性PHF采用HHR治疗。
