锁定柄式反向全肩关节置换术治疗老年复杂肱骨近端骨折：临床及影像学短期结果
Locked Stem Reverse Total Shoulder Arthroplasty for Complex Proximal Humerus Fracture in the Elderly: Clinical and Radiological Short-Term Results.
作者信息
Rivera Alberto R, Cardona Victor
机构信息
Hospital Menonita Guayama, Caguas, Puerto Rico.
San Juan Bautista School of Medicine, Caguas, Puerto Rico.
出版信息
J Shoulder Elb Arthroplast. 2024 Aug 16;8:24715492241266131. doi: 10.1177/24715492241266131. eCollection 2024.
PURPOSE
To evaluate both the short-term clinical and radiological results of reverse shoulder arthroplasty (RSA) with uncemented locked stem in the management of a proximal humerus fracture (PHFs) in the elderly.
METHODS
Retrospective study including 40 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 24 months follow-up. In all the cases, the greater tuberosity (GT) was reattached with a standardized suture technique and a local horseshoe bone graft. All the patients were assessed at the 24-month follow-up with Constant-Murley Score (CMS) and Visual Analog Score (VAS). Radiographic healing of the greater tuberosity was noted in addition to stem locking screws radiographic changes. Complications and revision rates were reported.
RESULTS
Mean final CMS for this cohort was 80 points. The greater tuberosity healed in the anatomic position in 90% of the cases (N = 36), obtaining an average CMS of 80 in these patients. Healing of the greater tuberosity did not occur in 10% of the cases (N = 4), obtaining an average CMS of 60. All patients scored above 100° in forward elevation with a mean of 140°. Mean active external rotation was 30°. Low-grade scapular notching was reported in <1% of the cases. Major complications were reported in one patient with an acromial fracture. No complications or loosening of stem locking screws were noted. There were no reoperations.
CONCLUSION
In the elderly population, reverse shoulder arthroplasty utilizing a fracture-specific locking stem, low-profile metaphysis, suture-friendly groove, meticulous suture technique, and local bone grafting allows adequate fixation, variable prosthesis height adjustment, and enhances greater tuberosity healing. This approach yields positive short-term clinical outcomes without complications related to the stem's locking screws.
LEVEL OF EVIDENCE
Level IV Retrospective Case Series.
目的
评估采用非骨水泥锁定柄的反肩置换术（RSA）治疗老年肱骨近端骨折（PHFs）的短期临床和影像学结果。
方法
回顾性研究，纳入40例连续的3-4部分肱骨近端骨折患者，均接受反肩置换术，随访至少24个月。所有病例均采用标准化缝合技术和局部马蹄形骨移植重新附着大结节（GT）。所有患者在24个月随访时采用Constant-Murley评分（CMS）和视觉模拟评分（VAS）进行评估。除了观察柄锁定螺钉的影像学变化外，还记录大结节的影像学愈合情况。报告并发症和翻修率。
结果
该队列的平均最终CMS为80分。90%的病例（N = 36）大结节在解剖位置愈合，这些患者的平均CMS为80分。10%的病例（N = 4）大结节未愈合，平均CMS为60分。所有患者前屈上举均超过100°，平均为140°。平均主动外旋为30°。<1%的病例报告有轻度肩胛切迹。1例患者发生肩峰骨折，报告为主要并发症。未发现柄锁定螺钉的并发症或松动。无再次手术情况。
结论
在老年人群中，采用骨折专用锁定柄、低轮廓干骺端、有利于缝合的凹槽、细致的缝合技术和局部骨移植的反肩置换术可实现充分固定、可变的假体高度调整，并促进大结节愈合。这种方法产生了积极的短期临床结果，且无与柄锁定螺钉相关的并发症。
证据水平
IV级回顾性病例系列。
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