Ippolito Giorgio, Lanzetti Riccardo Maria, Ferraro Sergio, Pace Valerio, Damo Marco, Surace Michele Francesco, Giai Via Alessio Davide Enrico, Crivellaro Michele, De Marinis Giancarlo, Spoliti Marco
Trauma & Orthopaedic Department, Icot Hospital "Marco Pasquali", 04100 Latina, Italy.
Orthopaedics and Traumatology Unit, Department of Emergeny and Acceptance, Azienda Ospedialiera San Camillo-Forlanini, 00152 Rome, Italy.
J Clin Med. 2024 Aug 8;13(16):4665. doi: 10.3390/jcm13164665.
: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. : In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). : No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. : The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems.
在过去几年中，短型干骺端套接式人工肱骨干已被引入用于反式肩关节置换术（RSA）。考虑到未来可能需要进行翻修手术，短柄在肱骨干力量分布、降低剪切应力和保留骨量方面可能具有优势。我们研究的主要目的是通过比较我们所研究的植入物与使用传统长柄植入物所获得的临床和放射学结果，来验证短柄假体在肱骨骨折手术治疗中的应用。
在这项多中心、对照前瞻性研究中，选择了125例近端三部分或四部分肱骨骨折患者并进行RSA治疗。A组（n = 53，平均年龄：75.6±5.6岁）使用短柄，B组（n = 72，平均年龄：71.76±3岁）使用长柄。在平均2年的随访中收集并分析主动活动范围（ROM）、Constant评分（CS）、快速DASH、美国肩肘外科医师协会肩关节（ASES）评分和视觉模拟量表（VAS）评分，以及肱骨和肩胛盂骨吸收情况（使用井上评分总和和西尔沃评分）。
在最终随访时，A组和B组在ROM、Constant评分（51.69±15.8对53.46±15.96，P>0.05）、快速DASH（31.5±21.81对28.79±13.72，P = 0.85）、ASES（82.53±17.79对84.34±15.24，P = 0.57）或VAS（0.53±1对0.56±1.07，P = 0.14）方面均未观察到统计学上的显著差异。两组在放射学参数方面也未发现统计学上的显著差异。在肱骨和肩胛盂骨吸收的平均程度方面也未发现统计学上的显著差异。
在反式肩关节置换术中使用短型干骺端套接式柄可被认为是治疗近端肱骨骨折的一种安全、有效且可行的选择。我们的结果令人鼓舞，在所提出的治疗方法与传统长柄之间未发现统计学上的显著差异。
