Zhang Qing, Shakya Sujan, Cao Yi, Xiang Ming, Xiang Zhou, Duan Xin
Department of Orthopedic Surgery, School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China.
Orthop Surg. 2025 Jun;17(6):1633-1643. doi: 10.1111/os.70018. Epub 2025 Apr 13.
This study provides a comparative analysis of clinical outcomes between primary and salvage reverse shoulder arthroplasty (RSA), offering valuable insights into the management of proximal humerus fracture (PHF). To evaluate the outcomes of patients treated with RSA as a primary procedure for acute PHF and to compare these with patients undergoing salvage RSA as a revision procedure for fracture sequelae of PHF.
A retrospective cohort study was conducted on 42 patients undergoing RSA for PHF between December 2014 and April 2022. The primary RSA group (n = 28, mean age 73.8 ± 4.5 years, 66-81 years) included patients with acute fractures, while the salvage RSA group (n = 14, mean age 62.1 ± 12.3 years, 47-83 years) comprised revision cases for fracture sequelae. Active range of motion (ROM), Visual Analog Scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) scores were assessed for all patients. Outcomes between the two groups were compared, along with radiographic outcomes and complications recorded at each follow-up. Categorical variables were analyzed using chi-square or Fisher's exact tests, while continuous variables were compared using independent t-tests or Mann-Whitney U tests based on data distribution.
At a mean follow-up of 56 months (24-106 months), no significant differences in gender (p = 0.469) or follow-up duration (p = 0.087) were observed. The salvage group exhibited comparable postoperative ROM (anterior flexion (AF): 101.4° ± 52.3° vs. 115.9° ± 29.1°; external rotation (ER): 26.4° ± 16.4° vs. 28.8° ± 14.1°; internal rotation (IR): 7 ± 2 vs. 7 ± 2; all p > 0.05) and clinical scores (VAS: 1.6 ± 1.9 vs. 1.2 ± 1.5; Constant: 74.1 ± 23.3 vs. 79.4 ± 15.9; ASES: 81.9 ± 15.4 vs. 84.0 ± 13.8; all p > 0.05) to the primary group. However, the salvage group demonstrated significant preoperative-to-postoperative improvements in AF (50.9°, p < 0.001), ER (5.4, p = 0.017), and functional scores (VAS: -4.6; Constant: + 36.9; ASES: + 45.8; all p < 0.05). Complications occurred in 14.3% of salvage cases (2 revisions for periprosthetic fracture and aseptic loosening) versus 3.6% in the primary group. No other major complications such as deep infection, instability, acromial stress fracture, or dislocation were recorded.
RSA achieves comparable functional and radiographic outcomes for both acute PHF and fracture sequelae over 4 years of follow-up. Salvage RSA provides substantial clinical improvement but carries a higher complication risk, emphasizing the need for meticulous surgical technique and patient selection.
本研究对初次和挽救性反肩关节置换术（RSA）的临床结果进行了对比分析，为肱骨近端骨折（PHF）的治疗提供了有价值的见解。旨在评估将RSA作为急性PHF的初次手术治疗患者的结果，并将其与接受挽救性RSA作为PHF骨折后遗症翻修手术的患者进行比较。
对2014年12月至2022年4月期间接受RSA治疗PHF的42例患者进行了一项回顾性队列研究。初次RSA组（n = 28，平均年龄73.8±4.5岁，66 - 81岁）包括急性骨折患者，而挽救性RSA组（n = 14，平均年龄62.1±12.3岁，47 - 83岁）包括骨折后遗症的翻修病例。对所有患者评估了主动活动范围（ROM）、视觉模拟评分（VAS）、Constant评分和美国肩肘外科医师（ASES）评分。比较了两组之间的结果，以及每次随访时记录的影像学结果和并发症。分类变量采用卡方检验或Fisher精确检验进行分析，连续变量根据数据分布采用独立t检验或Mann-Whitney U检验进行比较。
平均随访56个月（24 - 106个月）时，未观察到性别（p = 0.469）或随访时间（p = 0.087）的显著差异。挽救组术后ROM（前屈（AF）：101.4°±52.3°对115.9°±29.1°；外旋（ER）：26.4°±16.4°对28.8°±14.1°；内旋（IR）：7±2对7±2；所有p>0.05）和临床评分（VAS：1.6±1.9对1.2±1.5；Constant：74.1±23.3对79.4±15.9；ASES：81.9±15.4对84.0±13.8；所有p>0.05）与初次组相当。然而，挽救组在AF（50.9°，p<0.001）、ER（5.4，p = 0.017）和功能评分（VAS：-4.6；Constant：+36.9；ASES：+45.8；所有p<0.05）方面术前至术后有显著改善。挽救病例中有14.3%发生并发症（2例假体周围骨折和无菌性松动翻修），而初次组为3.6%。未记录到其他主要并发症，如深部感染、不稳定、肩峰应力性骨折或脱位。
在4年的随访中，RSA在急性PHF和骨折后遗症方面均取得了相当的功能和影像学结果。挽救性RSA可带来显著的临床改善，但并发症风险较高，强调了需要精细的手术技术和患者选择。
