Kahraman Sinan, Karslioglu Bulent, Imren Yunus, Keskin Ahmet, Bilsel Kerem, Dedeoglu Suleyman Semih
Department of Orthopedics and Traumatology, Demiroglu Bilim University, Buyukdere Cd. No: 120, Sisli, 34394 Istanbul, Turkey.
Department of Orthopedics and Traumatology, Prof. Cemil Tascioglu City Hospital, Health Sciences University, Istanbul, Turkey.
Indian J Orthop. 2024 Jan 23;58(3):263-270. doi: 10.1007/s43465-023-01084-1. eCollection 2024 Mar.
This multicenter retrospective study was conducted with the objective of comparing the outcomes and complications between inlay and onlay reverse shoulder arthroplasty (RSA) in patients presenting Neer Type 4 proximal humerus fractures and cuff tear arthropathy. The primary aim of this investigation was to assess and juxtapose the clinical as well as functional outcomes of individuals who underwent onlay reverse shoulder arthroplasty with those who underwent inlay reverse shoulder arthroplasty.
A retrospective cohort study was conducted, involving patients who had undergone reverse shoulder arthroplasty between the period of 2016 and 2022. The study divided the population into two groups: Group A received inlay humeral components, while Group B received onlay humeral components. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. Range of motion, infection, periprosthetic fractures, and nerve injuries were also assessed.
The study included 67 patients in Group A and 62 patients in Group B. Group A had significantly better functional outcomes, as indicated by higher ASES and Constant scores ( < 0.05). Group A also had greater shoulder joint motion ( < 0.05). Periprosthetic fractures were significantly more common in Group B ( < 0.05). However, complication rates, including infection and instability, did not significantly differ between the groups ( > 0.05). Nerve injuries occurred in both groups, with slightly higher occurrence in Group B.
Inlay humeral components in reverse shoulder arthroplasty for Neer Type 4 fractures and cuff tear arthropathy resulted in better functional outcomes, increased range of motion, and lower incidence of periprosthetic fractures compared to onlay components. Onlay components showed potential advantages in reducing instability rates. Further studies with larger samples and standardized protocols are needed to confirm these findings.
本多中心回顾性研究旨在比较接受Neer 4型肱骨近端骨折和肩袖撕裂性关节病的患者行嵌体式与覆盖式反肩关节置换术（RSA）后的疗效及并发症。本研究的主要目的是评估并对比接受覆盖式反肩关节置换术的患者与接受嵌体式反肩关节置换术的患者的临床及功能结局。
进行了一项回顾性队列研究，纳入2016年至2022年期间接受反肩关节置换术的患者。该研究将人群分为两组：A组接受嵌体式肱骨组件，而B组接受覆盖式肱骨组件。使用美国肩肘外科医师学会（ASES）评分和Constant评分评估功能结局。还评估了活动范围、感染、假体周围骨折和神经损伤情况。
该研究纳入A组67例患者和B组62例患者。A组的功能结局明显更好，ASES评分和Constant评分更高（<0.05）。A组的肩关节活动度也更大（<0.05）。假体周围骨折在B组明显更常见（<0.05）。然而，两组间包括感染和不稳定在内的并发症发生率无显著差异（>0.05）。两组均发生神经损伤，B组的发生率略高。
对于Neer 4型骨折和肩袖撕裂性关节病，反肩关节置换术中使用嵌体式肱骨组件比覆盖式组件能带来更好的功能结局、更大的活动范围以及更低的假体周围骨折发生率。覆盖式组件在降低不稳定发生率方面显示出潜在优势。需要进一步开展更大样本量和标准化方案的研究来证实这些发现。
