Ariztía Antonio, Calvo Andrés, Alba Vicente, Paccot Daniel, Bernal Nazira, Aravena Cristian, Reinares Felipe
Orthopaedics and Traumatology, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, CHL.
Orthopaedics and Traumatology, Hospital Clinico Mutual de Seguridad Cámara Chilena de la Construcción (CChC), Santiago, CHL.
Cureus. 2025 May 4;17(5):e83460. doi: 10.7759/cureus.83460. eCollection 2025 May.
Introduction Reverse shoulder arthroplasty (RSA) is an option for patients with complex fractures of the proximal humerus and a salvage option for osteosynthesis failure, fracture sequelae, and hemiarthroplasty (HA) revision. The objective of this study was to compare the functional outcomes of primary RSA for proximal humerus fractures (PHFs) with those of salvage RSA for the failed treatment of PHFs. We hypothesized that patients undergoing primary RSA would experience significantly less pain and better functional outcomes than those receiving RSA as a salvage procedure. Methods This was a retrospective cohort study of patients with PHFs who underwent RSA initially or as a salvage procedure due to failure of conservative treatment, osteosynthesis, or HA. The demographic characteristics of the patients and the radiological features of the initial fracture were considered. Functional outcomes were assessed in terms of range of motion (ROM), the Constant-Murley score (CMS), the subjective shoulder value (SSV), and pain (visual analog scale (VAS)). For the comparative statistical analysis, the t-test and Mann-Whitney U test were used. Results Ninety patients underwent RSA, but only 41 patients were included. There were 23 patients in the primary RSA group and 18 in the salvage RSA group, with an average follow-up of 15 months (12-80 months). The primary RSA group experienced significantly less pain (VAS: 0.5±0.13 vs. 1.8±0.40) (p=0.002) and had a better CMS functional index score (73.2±1.6 vs. 65±3.01) (p=0.01) at the end of the follow-up period. No differences in ROM (active anterior elevation and external or internal rotation) or SSV were observed between the two groups. Conclusions In this series of patients, ROM was similar among the patients who underwent primary RSA and those who underwent salvage RSA; however, those who underwent primary RSA had better but not clinically relevant CMS and significantly less pain.
引言
反肩关节置换术（RSA）是治疗肱骨近端复杂骨折患者的一种选择，也是骨固定失败、骨折后遗症及半关节置换术（HA）翻修的挽救性选择。本研究的目的是比较肱骨近端骨折（PHF）初次行RSA与PHF治疗失败后挽救性行RSA的功能结局。我们假设，与接受挽救性RSA手术的患者相比，初次行RSA的患者疼痛明显减轻，功能结局更好。
方法
这是一项回顾性队列研究，研究对象为因保守治疗、骨固定或HA失败而初次或挽救性接受RSA的PHF患者。考虑了患者的人口统计学特征和初始骨折的放射学特征。从活动范围（ROM）、Constant-Murley评分（CMS）、主观肩关节评分（SSV）和疼痛（视觉模拟量表（VAS））方面评估功能结局。采用t检验和Mann-Whitney U检验进行比较统计分析。
结果
90例患者接受了RSA，但仅41例患者被纳入研究。初次RSA组23例，挽救性RSA组18例，平均随访15个月（12 - 80个月）。随访期末，初次RSA组疼痛明显减轻（VAS：0.5±0.13 vs. 1.8±0.40）（p = 0.002），CMS功能指数评分更高（73.2±1.6 vs. 65±3.01）（p = 0.01）。两组间ROM（主动前举和外旋或内旋）及SSV无差异。
结论
在这组患者中，初次行RSA和挽救性行RSA的患者ROM相似；然而，初次行RSA的患者CMS更好，但无临床显著差异，且疼痛明显减轻。
