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肩袖缺损和肱骨近端骨折患者行反式肩关节置换术的疗效和安全性改善:22 例回顾性分析。

Enhanced Outcomes and Safety of Reverse Shoulder Arthroplasty in Rotator Cuff Deficiency and Proximal Humerus Fractures: A 22-Patient Retrospective Analysis.

机构信息

Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin, Turkey.

出版信息

Med Sci Monit. 2024 Aug 25;30:e945241. doi: 10.12659/MSM.945241.

DOI:10.12659/MSM.945241
PMID:39182164
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11360653/
Abstract

BACKGROUND Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of rotator cuff deficiency and proximal humerus fractures. This single-center study aimed to evaluate the outcomes from reverse shoulder arthroplasty for rotator cuff ınsufficiency and proximal humerus fractures in 22 patients from a single center. MATERIAL AND METHODS Twenty-two patients were included in the study. The median age of the patients was 66 years (Range: 58-95). Proximal humerus fractures were diagnosed using X-ray and CT, while rotator cuff tears were diagnosed using MRI. For the assessment of joint function, the Constant-Murley score, the American Shoulder and Elbow Surgeons (ASES), and the Disabilities of Arm, Shoulder, and Hand (DASH) scores were used as patient-reported outcome measures. Kaplan-Meier analysis was conducted to evaluate implant survival. RESULTS The mean follow-up duration was 4.05±1.2 years. Significant improvements were observed: ASES Score: Increased from 35.8±2.8 to 81.3±5.4 (p<0.001). VAS Pain Score: Decreased from 7.3±1 to 2.9±0.9 (p<0.001). DASH Score: Improved from 66.3±4.3 to 32.5±3.6 (p<0.001). Constant-Murley Score: Increased from 48.3±3.5 to 74.6±7.7 (p<0.001). Kaplan-Meier analysis estimated implant survival at 6.7 years (95% CI, 6.3-7.2). CONCLUSIONS When performed with appropriate indications, RSA yields positive results, as seen in the literature and our study. Interscalene block anesthesia, advancements in implant technology, and adherence to surgical procedures can reduce RSA complications and ensure its safe application.

摘要

背景

反式肩关节置换术(RSA)是一种被广泛接受的治疗方法,可在治疗肩袖缺损和肱骨近端骨折方面提供可重复的结果。本单中心研究旨在评估 22 例来自单一中心的肩袖缺损和肱骨近端骨折患者行反式肩关节置换术的结果。

材料和方法

本研究纳入 22 例患者。患者的中位年龄为 66 岁(范围:58-95 岁)。肱骨近端骨折通过 X 线和 CT 诊断,肩袖撕裂通过 MRI 诊断。为了评估关节功能,采用 Constant-Murley 评分、美国肩肘外科医师协会(ASES)评分和上肢残疾评分(DASH)作为患者报告的结果测量指标。采用 Kaplan-Meier 分析评估假体的存活率。

结果

平均随访时间为 4.05±1.2 年。观察到以下显著改善:ASES 评分:从 35.8±2.8 增加到 81.3±5.4(p<0.001)。VAS 疼痛评分:从 7.3±1 降低至 2.9±0.9(p<0.001)。DASH 评分:从 66.3±4.3 改善至 32.5±3.6(p<0.001)。Constant-Murley 评分:从 48.3±3.5 增加至 74.6±7.7(p<0.001)。Kaplan-Meier 分析估计假体的 6.7 年存活率(95%CI,6.3-7.2)。

结论

当适应症适当时,RSA 会产生如文献和我们的研究所示的积极结果。使用肌间沟阻滞麻醉、植入物技术的进步以及遵循手术程序可以减少 RSA 并发症并确保其安全应用。

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本文引用的文献

1
The effect of cuff arthropathy stage on sleep disturbance and kinesiophobia in reverse shoulder arthroplasty patients.肩袖关节炎患者肩袖关节炎分期对睡眠障碍和运动恐惧症的影响。
BMC Musculoskelet Disord. 2024 Mar 23;25(1):231. doi: 10.1186/s12891-024-07338-9.
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Comparison of Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Proximal Humerus Fractures Versus Rotator Cuff Arthropathy.肱骨近端骨折与肩袖关节炎患者行反式全肩关节置换术后疗效比较。
J Am Acad Orthop Surg Glob Res Rev. 2023 Oct 12;7(10). doi: 10.5435/JAAOSGlobal-D-23-00160. eCollection 2023 Oct 1.
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Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; medium-term results.
60岁及以下患者行反肩关节置换术后的临床结果;中期结果。
JSES Int. 2023 Jan 13;7(2):277-284. doi: 10.1016/j.jseint.2022.12.018. eCollection 2023 Mar.
4
Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years.反式全肩关节置换术在治疗 70 岁以上三部分和四部分肱骨近端骨折患者中优于角度稳定钢板。
Clin Orthop Relat Res. 2023 Apr 1;481(4):735-747. doi: 10.1097/CORR.0000000000002480. Epub 2022 Nov 15.
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Management of Proximal Humerus Fractures in Adults-A Scoping Review.成人肱骨近端骨折的管理——一项范围综述
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Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study.用于肱骨近端头劈裂骨折的反肩关节置换术——一项回顾性队列研究
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Primary treatment of complex proximal humerus fractures using Humelock cementless reversible shoulder arthroplasty in the elderly.老年患者使用 Humelock 非骨水泥可复位肩关节假体治疗复杂肱骨近端骨折。
Ulus Travma Acil Cerrahi Derg. 2021 Jul;27(4):457-464. doi: 10.14744/tjtes.2020.46879.
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Reverse Shoulder Arthroplasty for Proximal Humerus Fracture.用于肱骨近端骨折的反肩关节置换术
Curr Rev Musculoskelet Med. 2020 Apr;13(2):186-199. doi: 10.1007/s12178-020-09597-0.
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Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty.老年患者复杂肱骨近端骨折的手术治疗:角稳定钢板与反式肩关节置换的配对分析。
J Shoulder Elbow Surg. 2020 Sep;29(9):1796-1803. doi: 10.1016/j.jse.2020.01.073. Epub 2020 Apr 9.
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J Bone Joint Surg Am. 2020 Mar 18;102(6):477-485. doi: 10.2106/JBJS.19.01071.