Halvorson Ryan T, Su Favian, Ghanta Ramesh B, Garcia-Lopez Edgar, Lalchandani Gopal Ram, Shapiro Lauren Michelle
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2025 Mar;34(3):853-859. doi: 10.1016/j.jse.2024.06.003. Epub 2024 Aug 7.
Reverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race.
The National Surgical Quality Improvement Program database was queried for ORIF, rTSA, and hemiarthroplasty between 2006 and 2020 for patients with a PHF. Race, ethnicity, age, sex, body mass index, and American Society of Anesthesiologists (ASA) class were recorded. Chi squared tests were performed to assess relationships between patient factors and operative intervention. Factors significant at the 0.10 level in univariable analyses were included in a multivariable multinomial model to predict operative intervention.
Seven thousand four hundred ninety-nine patients underwent surgical treatment for a PHF, including 526 (7%) undergoing hemiarthroplasty, 5011 (67%) undergoing ORIF, and 1962 (26%) undergoing rTSA. 27% of white patients with PHF underwent rTSA compared to 21% of Black patients, 16% of Asian patients, and 14% of Native American and Alaskan Native patients (P < .001). In the multivariable analysis, utilization of rTSA increased over time (OR 1.2 per year since 2006, P < .001) and hemiarthroplasty decreased over time (OR 0.86 per year since 2006, P < .001). Non-White patients had significantly lower odds of undergoing rTSA vs. ORIF (OR 0.75, 95% CI 0.58-0.97), as did male patients (OR 0.77, 95% CI 0.66-0.88). Patients over 65 (OR 3.86, 95% CI 3.39-4.38), patients with higher ASA classifications (ASA2: OR 3.24, 95% CI 1.86-5.66, ASA3: OR 4.77, 95% CI 2.74-8.32, ASA4: OR 5.25, 95% CI 2.89-9.54), and patients who were overweight (OR 1.33, 95% CI 1.14-1.55) or obese (OR 1.52, 95% CI 1.32-1.75) had higher odds of undergoing rTSA vs. ORIF.
As utilization of rTSA increases, understanding disparities in surgical treatment of PHF is crucial to improving outcomes and equitable access to emerging orthopedic technologies. While patient factors such as age, body mass index, and comorbidities are known to directly impact outcomes and thus may be predictive of the type of surgical intervention, patient race should not dictate treatment.
反向全肩关节置换术（rTSA）在肱骨近端骨折（PHF）的手术治疗中越来越受欢迎。本研究的目的是比较切开复位内固定术（ORIF）、半关节成形术和rTSA在PHF手术治疗中的种族差异。我们的假设是不同种族在固定方式上没有差异。
查询2006年至2020年国家外科质量改进计划数据库中接受PHF治疗的患者的ORIF、rTSA和半关节成形术的相关数据。记录种族、民族、年龄、性别、体重指数和美国麻醉医师协会（ASA）分级。进行卡方检验以评估患者因素与手术干预之间的关系。单变量分析中在0.10水平上具有显著性的因素被纳入多变量多项模型以预测手术干预。
7499例患者接受了PHF手术治疗，其中526例（7%）接受半关节成形术，5011例（67%）接受ORIF，1962例（26%）接受rTSA。27%的白人PHF患者接受了rTSA，相比之下，黑人患者为21%，亚洲患者为16%，美洲原住民和阿拉斯加原住民患者为14%（P <.001）。在多变量分析中，rTSA的使用率随时间增加（自2006年起每年OR为1.2，P <.001），半关节成形术的使用率随时间下降（自2006年起每年OR为0.86，P <.001）。与接受ORIF相比，非白人患者接受rTSA的几率显著较低（OR为0.75，95%CI为0.58 - 0.97），男性患者也是如此（OR为0.77，95%CI为0.66 - 0.88）。65岁以上的患者（OR为3.86，95%CI为3.39 - 4.38）、ASA分级较高的患者（ASA2：OR为3.24，95%CI为1.86 - 5.66，ASA3：OR为4.77，95%CI为2.74 - 8.32，ASA4：OR为5.25，95%CI为2.89 - 9.54）以及超重（OR为1.33，95%CI为1.14 - 1.55）或肥胖（OR为1.52，95%CI为1.32 - 1.75）的患者接受rTSA与接受ORIF相比的几率更高。
随着rTSA使用率的增加，了解PHF手术治疗中的差异对于改善治疗效果和公平获得新兴骨科技术至关重要。虽然年龄、体重指数和合并症等患者因素已知会直接影响治疗效果，因此可能预测手术干预的类型，但患者种族不应决定治疗方式。
