使用近端涂层柄治疗肱骨近端骨折的反肩关节置换术中的应力遮挡：它具有临床相关性吗？
Stress shielding in reverse shoulder arthroplasty using a proximally coated stem for proximal humeral fractures: Does it have clinical relevance?
作者信息
Goñalons-Giol Francesc, Ventura-Parellada Cristina, Alonso-Rodríguez-Piedra Javier, Llorens-Martínez Xavier, Gàmez-Baños Ferran, Mora-Guix José-María
机构信息
Orthopaedic and Trauma Surgery Department, Hospital de Terrassa, Terrassa, Barcelona, Spain.
出版信息
Shoulder Elbow. 2025 Jan 7:17585732241309899. doi: 10.1177/17585732241309899.
OBJECTIVES
To evaluate the clinical significance of stress shielding in patients who have undergone an uncemented reverse shoulder arthroplasty (RSA) with a proximally coated stem for complex proximal humeral fractures (PHF) comprising 3 or 4 parts, assessed at 2 years postoperatively. Additionally, this study aims to examine the correlation between tuberosity healing and clinical outcomes.
METHODS
Single Centre. 43 patients underwent surgery involving a cementless RSA with an anatomical stem (Mini Stem of Zimmer Biomet Comprehensive System) following an acute 3- or 4-part or 4-part with luxation PHF within 4 weeks of injury. Patients who were excluded from the study included those who passed away, did not have a minimum 2-year follow-up, or had undergone cemented RSAs or alternative humeral components, as well as those who required RSA due to fracture sequelae. Stress shielding, tuberosity healing and its positioning were evaluated. Clinical-functional assessments were made using the Constant and ASES scores. Furthermore, quality of life assessments, including QuickDASH score, SF-12, satisfaction test (SANE) and Visual Analogue Scale (VAS) were performed.
RESULTS
Of the total shoulders, 6 (13.9%) were excluded, leaving 37 PHFs that met the inclusion criteria. The mean age at the time of surgery was 72 years (range, 61-85). Stress shielding was observed in 31 shoulders (83.8%). There was no observed correlation between stress shielding and clinical-functional or quality of life assessments. The greater tuberosity in patients without stress shielding was found to be above the tray (66.7%) ( < 0.05). Tuberosity healing was observed in 94.6% (35/37) of the shoulders.
CONCLUSIONS
No significant clinical difference was observed between patients with and without stress shielding in terms of short-term functional outcomes. Successful consolidation of the tuberosities can be attained even in cases with notable stress shielding.
LEVEL OF EVIDENCE
Level IV; Case Series; Treatment study.
目的
评估接受非骨水泥型反肩关节置换术（RSA）且近端涂层柄用于治疗复杂三部分或四部分近端肱骨骨折（PHF）患者的应力遮挡的临床意义，术后2年进行评估。此外，本研究旨在探讨结节愈合与临床结果之间的相关性。
方法
单中心研究。43例患者在受伤后4周内接受了使用解剖型柄（捷迈邦美综合系统的Mini柄）的非骨水泥型RSA手术，治疗急性三部分或四部分或四部分合并脱位的PHF。被排除在研究之外的患者包括那些去世的、随访时间不足2年的、接受了骨水泥型RSA或其他肱骨组件的患者，以及因骨折后遗症而需要进行RSA的患者。评估应力遮挡、结节愈合及其位置。使用Constant和ASES评分进行临床功能评估。此外，还进行了生活质量评估，包括QuickDASH评分、SF-12、满意度测试（SANE）和视觉模拟量表（VAS）。
结果
在所有肩部中，6例（13.9%）被排除，剩下37例符合纳入标准的PHF。手术时的平均年龄为72岁（范围61-85岁）。31例肩部（83.8%）观察到应力遮挡。应力遮挡与临床功能或生活质量评估之间未观察到相关性。在没有应力遮挡的患者中，发现大结节位于托盘上方的比例为66.7%（<0.05）。94.（35/37）的肩部观察到结节愈合。
结论
在短期功能结果方面，有应力遮挡和无应力遮挡的患者之间未观察到显著的临床差异。即使在存在明显应力遮挡的情况下，结节也能成功愈合。
证据水平
IV级；病例系列；治疗研究。
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