Maassen Doreen, Welter JoEllen, Fischer Marcel, Pieringer Alexander, Mazel Peter, Mazzucchelli Ruben, Horn Nils, Müller Andreas, Hess Florian
Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
Int Orthop. 2025 Jan;49(1):167-175. doi: 10.1007/s00264-024-06368-1. Epub 2024 Nov 13.
Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index.
The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing.
The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80-95), the median CS Score was 76.5 (IQR 72-81), and the median ASES Score was 89.9 (IQR 82-93). The ROM measurements were: median active forward flexion 140° (IQR 120-160), median external rotation 30° (IQR 20-40), and median active internal rotation 6 (IQR 4-8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group.
Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications.
反肩关节置换术（RSA）是治疗老年肱骨近端骨折的常见外科手术。肱骨干的骨水泥固定被认为是该手术的金标准。由于该患者群体骨质疏松症的高患病率，使用非骨水泥型假体柄时术中骨折风险增加。假体柄松动是使用非骨水泥型假体柄的另一个问题。然而，使用骨水泥与骨水泥栓塞风险、结节愈合受损以及后期翻修的技术困难相关。本研究旨在（i）评估术后两年接受非骨水泥型RSA治疗肱骨近端骨折患者的临床和放射学结果，以及（ii）比较根据三角肌粗隆指数测量的低骨质量降低和未降低的患者之间的这些结果。
这项单中心前瞻性研究纳入了2019年至2022年间54例（52例患者）肱骨近端骨折的肩部病例。纳入的患者年龄在65岁及以上，患有急性或继发性移位的三部分或四部分骨折或头劈裂骨折，采用相同的非骨水泥系统和结节重新固定进行RSA治疗。术后24个月，临床评估包括活动范围（ROM）、Constant-Murley评分（CS）、主观肩关节评分（SSV）和美国肩肘外科医师（ASES）评分。放射学评估包括肩胛切迹、透亮线和大结节愈合情况。
平均年龄为79岁（±8），87%为女性，69%患有骨质疏松性骨折。在两年随访时，SSV中位数为90%（四分位间距80 - 95），CS评分中位数为76.5（四分位间距72 - 81），ASES评分中位数为89.9（四分位间距82 - 93）。ROM测量结果为：主动前屈中位数140°（四分位间距120 - 160），外旋中位数30°（四分位间距20 - 40），主动内旋中位数6（四分位间距4 - 8）。大结节愈合率为94.5%。尽管骨质疏松性骨折在老年患者中更常见（平均分别为81岁和72岁），但两组之间未发现其他显著差异。非骨质疏松组发生1例无菌性假体柄松动。
即使在骨质疏松性肱骨近端骨折中，非骨水泥型假体柄联合结节重新固定也能产生良好的结果，且不增加并发症。
