From the Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington (Schiffman), the Summit Health Orthopedics, Berkeley Heights, NJ (Cohn), and the Departments of Orthopaedic Surgery and Shoulder and Elbow Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, PA (Austin and Namdari).
J Am Acad Orthop Surg. 2024 Aug 1;32(15):681-691. doi: 10.5435/JAAOS-D-23-00740. Epub 2024 May 3.
While several proximal humerus fractures treated nonsurgically reach satisfactory outcomes, some become symptomatic malunions or nonunions with pain and dysfunction. When joint-preserving options such as malunion or nonunion repair are not optimal because of poor remaining bone stock or glenohumeral arthritis, shoulder arthroplasty is a good option. Because of the semiconstrained design of reverse shoulder arthroplasty, it is effective at improving function when there is notable bony deformity or a torn rotator cuff. Clinical studies have demonstrated reliable outcomes, and a classification system exists that is helpful for predicting prognosis and complications. By understanding the associated pearls and pitfalls and with careful management of the tuberosities, reverse shoulder arthroplasty is a powerful tool for managing proximal humerus fracture sequelae.
虽然一些非手术治疗的肱骨近端骨折可获得满意的结果，但有些会出现疼痛和功能障碍的症状性畸形愈合或骨不连。当由于剩余骨量差或肩关节炎而使保留关节的选择（如畸形愈合或骨不连修复）不理想时，肩关节置换术是一个不错的选择。由于反式肩关节置换术的半约束设计，当存在明显的骨畸形或肩袖撕裂时，它可有效地改善功能。临床研究已经证明了其可靠的结果，并且存在一种分类系统有助于预测预后和并发症。通过了解相关的要点和陷阱，并小心管理结节，反式肩关节置换术是处理肱骨近端骨折后遗症的有力工具。
