Blaas Leanne S, Lameijer Charlotte M, Alta Tjarco Dw, Yuan Jian Z, van Dieren Susan, Bloemers Frank W, van Noort Arthur, Derksen Robert Jan
Department of Trauma Surgery, Zaandam Medical Centre, Zaandam, The Netherlands.
Department of Trauma Surgery, Amsterdam UMC, Location Boelelaan, Research Institute Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Shoulder Elbow. 2024 Oct;16(5):559-568. doi: 10.1177/17585732231190038. Epub 2023 Jul 28.
This multicentre retrospective cohort study assessed whether functional outcomes after primary reverse shoulder arthroplasty (RSA) are favourable compared to secondary placement in elderly patients with displaced proximal humerus fractures (PHFs).
Fifty-three patients with primary and 32 with secondary RSA were included. Patient-reported outcome measures (PROMs) were assessed: Constant-Murley Score (CMS), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS). In addition, range of motion (ROM) was compared between groups.
For PROMs, the means (SD) for primary versus secondary were 25.4 (17.7), 29.4 (19.2) for DASH; 38 (8.6), 38 (9.1) for OSS; 63 (19.8), 59 (22.0) for CMS and 2 (2.0), 3 (2.3) for VAS. For ROM, the means were the following: forward flexion 113° (33.6), 106° (34.1); abduction 103° (33.4), 96° (37.3) and external rotation 20° (19.1), 20° (17.8). There were significant differences in favour of primary treatment in forward flexion (p = 0.003, B 19.85) and abduction (p = 0.034, B 17.34).
ROM in patients with complex displaced PHFs after primary RSA is slightly better than that after secondary treatment. Therefore, RSA could be considered primary treatment, especially when optimal ROM is of great importance to the patient.
level III, retrospective comparative study treatment study.
这项多中心回顾性队列研究评估了在老年肱骨近端移位骨折（PHF）患者中，初次反肩关节置换术（RSA）后的功能结果与二次置换相比是否更有利。
纳入53例行初次RSA和32例行二次RSA的患者。评估患者报告的结局指标（PROMs）：Constant-Murley评分（CMS）、牛津肩关节评分（OSS）、手臂、肩部和手部功能障碍（DASH）评分以及视觉模拟量表（VAS）。此外，比较两组之间的活动范围（ROM）。
对于PROMs，初次与二次置换的DASH评分均值（标准差）分别为25.4（17.7）、29.4（19.2）；OSS评分分别为38（8.6）、38（9.1）；CMS评分分别为63（19.8）、59（22.0）；VAS评分为2（2.0）、3（2.3）。对于ROM，均值如下：前屈113°（33.6）、106°（34.1）；外展103°（33.4）、96°（37.3）；外旋20°（19.1）、20°（17.8）。在前屈（p = 0.003，B 19.85）和外展（p = 0.034，B 17.34）方面，初次治疗有显著优势。
初次RSA后复杂移位PHF患者的ROM略优于二次治疗后。因此，RSA可被视为首选治疗方法，尤其是当最佳ROM对患者非常重要时。
III级，回顾性对比研究治疗研究。
