Vaccaro Ramiro, Rossi Luciano Andrés, Larrague Catalina, Farias Ignacio, Domenech Ignacio, Tanoira Ignacio, Ranalletta Maximiliano
Hospital Italiano de Buenos Aires, Instituto de ortopedia y traumatología Prof Dr Carlos E Ottolenghi, Buenos Aires, Argentina.
Hospital Italiano de Buenos Aires, Instituto de ortopedia y traumatología Prof Dr Carlos E Ottolenghi, Buenos Aires, Argentina.
J Shoulder Elbow Surg. 2025 Jun 3. doi: 10.1016/j.jse.2025.04.030.
The purpose of this study was to compare the functional outcomes, complications, and revision rates of reverse total shoulder arthroplasty (rTSA) for the treatment of proximal humeral fractures (PHFs) in patients who achieved anatomical tuberosity healing and those treated with rTSA for rotator cuff arthropathy (RCA) after a minimum follow-up period of 8 years.
This was a retrospective comparative cohort study. We included patients aged ≥65 years with an acute PHF (<4 weeks from injury) or RCA treated with rTSA who had at least 8 years follow-up. Patients were divided in 3 groups for clinical assessment: Group 1: rTSA for PHF in which anatomical tuberosity healing was achieved, Group 2: rTSA for PHF in which anatomical tuberosity healing was not achieved (including nonunions and malunions of the tuberosities) Group 3: rTSA for RCA. We assessed range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale, single numerical evaluation (SANE) score, complications and revisions.
The mean follow-up for all 3 groups was 9.5 ± 1.5 years, and the mean age was 71.9 ± 7 years with no significant differences between the groups. There were 76 women (65%) no significant differences were observed in the ASES score between Group 1 82 (±7) and Group 3 83 (±7), with a difference between the 2 groups of 1 (95% CI: -4.5 to 2). In contrast, both groups were significantly superior to Group 2 73 (±4) (P < .001). Although there was no significant difference between the percentage of patients who achieved the Patient Acceptable Symptom State for the ASES between Group 1 (74%) and Group 3 (78%) both groups were significantly superior to Group 2 (65%) (P < .001). No significant differences were observed in the visual analog scale for pain among the 3 groups. No significant differences were observed in the SANE score between Group 1 78 (±9) and Group 3 80 (±8), with a difference between the 2 groups of 2 (95% confidence interval: 1.5-5.7). However, both groups were significantly superior to Group 2 69 (±9) (P < .001). Although there was no significant difference between the percentage of patients who achieved the Patient Acceptable Symptom State for the SANE between Group 1 (70%) and Group 3 (74%) both groups were significantly superior to Group 2 (61%) (P < .001) Regarding range of motion, Group 3 demonstrated significantly better flexion 140 (±10) compared to Groups 1 120 (±9) and 2 120 (±11) (P < .001), with no significant differences between Groups 1 and 2. Group 3 demonstrated significantly better external rotation 26 (±7) than Groups 1 20 (±6) and 2 16 (±8) (P < .001), with no significant differences between Groups 1 and 2. Similarly, for internal rotation, significant differences were found only between Groups 2 31 (±9) and 3 35 (±8) (P = .011). There were no significant differences between the groups regarding complications and revisions.
In the long term (mean follow-up of 9.5 years), there were no significant differences in functional outcomes, complications, or revision rates between patients over 65 years of age who underwent rTSA for the treatment of PHFs who achieved anatomical tuberosity healing and those treated for RCA. In contrast, in patients operated on for PHFs with rTSA where the tuberosities did not heal anatomically, although satisfactory results were obtained, the improvement in functional scores was significantly lower than in those with tuberosity consolidation or those operated on for RCA.
本研究旨在比较在至少8年的随访期后，接受反式全肩关节置换术（rTSA）治疗且实现解剖学结节愈合的肱骨近端骨折（PHF）患者与接受rTSA治疗肩袖关节病（RCA）患者的功能结局、并发症及翻修率。
这是一项回顾性比较队列研究。我们纳入了年龄≥65岁、接受rTSA治疗的急性PHF（受伤后<4周）或RCA且至少随访8年的患者。患者分为3组进行临床评估：第1组：接受rTSA治疗且实现解剖学结节愈合的PHF患者；第2组：接受rTSA治疗但未实现解剖学结节愈合的PHF患者（包括结节不愈合和畸形愈合）；第3组：接受rTSA治疗的RCA患者。我们评估了活动范围、美国肩肘外科医师（ASES）评分、视觉模拟量表、单一数值评估（SANE）评分、并发症及翻修情况。
所有3组的平均随访时间为9.5±1.5年，平均年龄为71.9±7岁，组间无显著差异。共有76名女性（65%）。第1组（82±7）和第3组（83±7）的ASES评分无显著差异，两组之间的差异为1（95%可信区间：-4.5至2）。相比之下，这两组均显著优于第2组（73±4）（P<.001）。虽然第1组（74%）和第3组（78%）达到患者可接受症状状态的ASES患者百分比之间无显著差异，但两组均显著优于第2组（65%）（P<.001）。3组之间在疼痛视觉模拟量表上未观察到显著差异。第1组（78±9）和第3组（80±8）的SANE评分无显著差异，两组之间的差异为2（95%置信区间：1.5-5.7）。然而，这两组均显著优于第2组（69±9）（P<.001）。虽然第1组（70%）和第3组（74%）达到患者可接受症状状态的SANE患者百分比之间无显著差异，但两组均显著优于第2组（61%）（P<.001）。关于活动范围，第3组的屈曲度（140±10）明显优于第1组（120±9）和第2组（120±11）（P<.001），第1组和第2组之间无显著差异。第3组的外旋度（±7）明显优于第1组（20±6）和第2组（16±8）（P<.001），第1组和第2组之间无显著差异。同样，在内旋方面，仅在第2组（31±9）和第3组（35±8）之间发现显著差异（P=.011）。各组之间在并发症及翻修方面无显著差异。
长期来看（平均随访9.5年），接受rTSA治疗且实现解剖学结节愈合的65岁以上PHF患者与接受rTSA治疗的RCA患者在功能结局、并发症或翻修率方面无显著差异。相比之下，在接受rTSA治疗的PHF患者中，若结节未实现解剖学愈合，尽管获得了满意的结果，但功能评分的改善明显低于结节愈合或接受rTSA治疗RCA的患者。
