肱骨近端骨折的反向全肩关节置换术:初治还是治疗失败后延迟?

Injury Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI:10.1016/j.injury.2023.111040
D González-Quevedo, N Fernández-Arroyabe, D J Moriel-Garceso, F J Martínez-Malo, F Martín-García, J Arenas-Ros, S Zambrana-Vico, L Puerta-Migueles, M Sáez-Casado, A Sánchez-García, I Tamimi
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引用次数: 0

摘要

背景:反向全肩关节置换术(RTSA)近来已成为治疗肱骨近端骨折(PHF)或其他治疗失败后的一种挽救手术。本研究的目的是比较初次RTSA与延迟RTSA在治疗移位肱骨近端骨折中的效果:本研究对2013年5月至2021年12月期间,在保守治疗或骨合成术失败后接受初次或延迟RTSA治疗的PHFs患者进行了回顾性队列研究。临床数据来自本地计算机数据库。随访结束时记录了并发症、活动范围以及功能结果。临床结果之间的差异采用逻辑回归分析法进行分析:本研究共纳入了 70 名患者(41 名原发性 RTSA 患者和 29 名延迟性 RTSA 患者)。平均随访时间分别为 112 个月和 60 个月。根据Neer分类法、ASA评分或并发症的出现情况,两组患者的骨折类型无差异。接受初级 RTSA 的患者 Q-DASH 和牛津肩关节评分明显更高(分别为 49.8 分 vs 31.4 分,p = 0.006 和 37.2 分 vs 27.5 分,p = 0.004)。此外,初级 RTSA 比延迟 RTSA 获得了更多的屈曲度和外展度(96.8 对 72.9,P=0.004):与延迟 RTSA 相比,初级 RTSA 治疗 PHF 的功能效果更好,活动范围更广。然而,初级和延迟RTSA的并发症和再干预率相似:3.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reverse total shoulder arthroplasty for proximal humerus fractures: Primary or delayed after failed treatment?

Background: Reverse total shoulder arthroplasty (RTSA) has recently become an option for the treatment of proximal humerus fractures (PHFs) or as a salvage procedure after failure of another treatment. The purpose of this study was to compare primary RTSA with delayed RTSA in the treatment of displaced PHFs.

Study design & methods: A retrospective cohort study was conducted on patients with PHFs who were treated between May 2013 and December 2021 with primary or delayed RTSA after failure of conservative treatment or osteosynthesis. Clinical data were withdrawn from our local computerized database. Complications, active range of motion, as well as the functional outcome were recorded at the end of the follow-up period. Differences between clinical outcomes were analyzed using a logistic regression analysis.

Results: A total of 70 individuals were included in this study (41 primary RTSA and 29 delayed RTSA). The mean of follow-up time was of 112 and 60 months, respectively. There were no differences between groups regarding fracture type according Neer Classification, ASA score or the presence of complications. Q-DASH and Oxford Shoulder scores were significantly better when patients underwent a primary RTSA (49.8 vs 31.4, p = 0.006 and 37.2 vs 27.5, p = 0.004 respectively). In addition, primary RTSA achieved more degrees of flexion and abduction than delayed RTSA (96.8 vs 72.9, p < 0.001 and 94.1 vs 69.3, p < 0.001 respectively).

Conclusion: Primary RTSA for PHFs achieved better functional outcomes and a wider range of motion when compared with delayed RTSA. However, primary and delayed RTSA have similar complication and reintervention rates.

Level of clinical evidence: 3.

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