Gaj Edoardo, Redler Andrea, Maggiori Alessandro, Pagnotta Susanna, Criseo Natale, Mirle Vikranth, Daggett Matthew, De Carli Angelo
Rome Jewish Hospital, 00186 Rome, Italy.
Orthopedic Department, S. Andrea Hospital, University of Rome "Sapienza", 00185 Rome, Italy.
J Clin Med. 2025 Jul 24;14(15):5257. doi: 10.3390/jcm14155257.
: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. : Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. : The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; = 0.0001), as well as forward flexion (147.50° vs. 90.00°; < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) ( = 0.01). The loss of subscapularis surface was greater in the RTSA patients ( = 0.018). : RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA.
半关节成形术（HA）和反式全肩关节置换术（RTSA）都是治疗复杂肱骨近端骨折的可靠选择。肩胛下肌腱在HA中的作用已明确，而在RTSA中其作用存在争议。本研究的目的是评估其在接受HA和RTSA治疗的肱骨近端骨折患者中的作用，并研究其与临床结果的关联。：2015年6月至2020年5月，连续68例肱骨近端骨折患者被前瞻性纳入研究（RTSA组 = 36例；HA组 = 32例）。术前行肩关节CT扫描测量肩胛下肌横截面积（SMCSA）和冈上肌窝横截面积（SFCSA）。采用SMCSA/SFCSA比值对个体患者解剖结构进行测量标准化。在最终随访时评估患者报告结局（PROs）和活动范围（ROM）。：与HA组相比，RTSA组患者报告结局（PROs）和活动范围（ROM）更佳。值得注意的是，RTSA组的Constant评分显著更高（58.00对38.50；P = 0.0001），前屈角度也更大（147.50°对90.00°；P < 0.0001）。RTSA患者术后肩胛下肌尺寸减小>35%的发生率（55.6%）高于HA患者（25%）（P = 0.01）。RTSA患者肩胛下肌表面的损失更大（P = 0.018）。：与HA相比，RTSA显示出更好的结果，提供了更好 的ROM和PROs。与HA相比，RTSA术后肩胛下肌尺寸减小显著更高。在RTSA中，肩胛下肌状况似乎与功能结局无相关性。
