Xu Joshua, Sivakumar Brahman S, Nandapalan Haren, Moopanar Terence, Harries Dylan, Page Richard, Symes Michael
Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards, Australia.
Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, Australia.
Eur J Orthop Surg Traumatol. 2024 Dec 28;35(1):48. doi: 10.1007/s00590-024-04165-5.
Proximal humerus fractures (PHF) are common with approximately 30% requiring surgical intervention. This ranges from open reduction internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population.
Data was retrospectively collected for private patients with a PHF and requiring surgical intervention (2001-2020). Data for patients undergoing ORIF were extracted from the Medicare database, while those receiving arthroplasty for PHF were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).
Across the study period, ORIF was the most common surgical procedure for management of PHFs. While the number of RTSA procedures for PHF has increased, shoulder hemiarthroplasty has significantly reduced since 2008 (p < 0.001). Patients aged < 65 years were more likely to receive ORIF. Patients aged ≥ 65 years were more likely to receive RTSA or hemiarthroplasty compared to patients aged < 65 years.
While the number of ORIF procedures has increased during the period of interest, it has diminished slightly as a proportion of overall procedure volume. RTSA is becoming increasingly popular, with decreasing utilization of hemiarthroplasty, and TSA for fracture remaining uncommon.
Level III.
肱骨近端骨折（PHF）很常见，约30%需要手术干预。手术方式从切开复位内固定（ORIF）到肩关节置换术（包括半关节置换术、全肩关节置换术（TSA）、反式全肩关节置换术（RTSA））。本研究的目的是评估澳大利亚人群中PHF手术干预的趋势。
回顾性收集2001年至2020年因PHF需要手术干预的私立患者的数据。接受ORIF的患者数据从医疗保险数据库中提取，而接受PHF关节置换术的患者数据则从澳大利亚骨科协会国家关节置换登记处（AOANJRR）获得。
在整个研究期间，ORIF是治疗PHF最常见的手术方法。虽然用于PHF的RTSA手术数量有所增加，但自2008年以来，肩关节半关节置换术显著减少（p<0.001）。年龄<65岁的患者更有可能接受ORIF。与年龄<65岁的患者相比，年龄≥65岁的患者更有可能接受RTSA或半关节置换术。
在感兴趣的时间段内，虽然ORIF手术数量有所增加，但作为总体手术量的一部分，其略有减少。RTSA越来越受欢迎，半关节置换术的使用率下降，而用于骨折的TSA仍然不常见。
三级。
