Cox Ryan M, Mandava Nikhil, Vaughan Alayna, Ramsey Matthew L, Getz Charles L, Namdari Surena
Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Shoulder Elbow. 2025 Apr;17(2):182-188. doi: 10.1177/17585732241239952. Epub 2024 Mar 18.
The purpose of this retrospective study was to analyze time to fracture union, complications, and outcomes of postoperative periprosthetic humerus fractures after primary shoulder arthroplasty.
Retrospective review of patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty at a single institution. Fractures were classified according to the Worland Classification system. Both non-operatively and operatively treated patients were included. The primary study outcomes were time to union and complications.
There were 46 patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty, 18 were treated non-operatively and 28 were treated operatively. There were seven (25%) patients who underwent surgery after failed non-operative management. There was only one (2.2%) patient who had a nonunion at final follow-up. The average American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeral Evaluation, and visual analog scale pain scores were 73.5 ± 22.7, 66.5 ± 23.1, and 2.2 ± 2.4, respectively.
There was a high rate of union for both non-operatively and operatively treated periprosthetic fractures. However, there was a high rate of cross-over from non-operative to operative treatment and a high complication rate for both cohorts. For properly indicated patients, non-operative and operative treatment can result in satisfactory patient outcomes.
本回顾性研究的目的是分析初次肩关节置换术后假体周围肱骨骨折的骨折愈合时间、并发症及预后情况。
对在单一机构接受初次肩关节置换术后发生假体周围肱骨骨折的患者进行回顾性研究。骨折根据沃兰德分类系统进行分类。纳入非手术治疗和手术治疗的患者。主要研究结局为骨折愈合时间和并发症。
46例患者在初次肩关节置换术后发生假体周围肱骨骨折，18例接受非手术治疗，28例接受手术治疗。7例（25%）患者在非手术治疗失败后接受了手术。末次随访时仅有1例（2.2%）患者骨折未愈合。美国肩肘外科医师协会肩关节评分、单项评估数值评定法及视觉模拟评分法疼痛评分的平均值分别为73.5±22.7、66.5±23.1和2.2±2.4。
非手术治疗和手术治疗的假体周围骨折愈合率均较高。然而，非手术治疗转为手术治疗的比例较高，且两组的并发症发生率均较高。对于适应证合适的患者，非手术治疗和手术治疗均可取得满意的患者预后。
