反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折

Reverse total shoulder arthroplasty for the treatment of old fracture of proximal humerus in elderly patients

目的:探讨采用反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折的临床疗效。方法:自2012年1月至2017年12月行反球式全肩关节置换术治疗12例老年肱骨近端陈旧性骨折患者,男5例,女7例;年龄63~81岁,平均70.2岁;病程9~18个月,平均12.3个月。采用VAS评分评价肩关节疼痛缓解程度,Constant-Murley评分评价肩关节功能改善情况,统计患者术中及术后并发症。结果:12例全部获得随访,时间15~56个月,平均22.3个月。术后12个月随访时VAS评分(1.9±1.4)分,Constant-Murley评分(83.4±8.4)分;肩关节前屈(92.5±7.7)°,外展(90.4±14.3)°,外旋(31.9±10.0)°,内旋(58.9±13.1)°;术前后差异均有统计学意义(P<0.05)。2例发生肩胛盂切迹,影像学表现分别为Ⅰ级和Ⅱ级,随访未发现松动等表现,无病例发生感染、肩峰骨折、假体松动,腋神经损伤等其他并发症。结论:反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折可以获得满意的疗效,但应注意适应证及并发症。

Objective:To investigate clinical results of reverse total shoulder arthroplasty in treating old fracture of proximal humerus in elderly patients.Methods:From January 2012 to December 2017,12 elderly patients with old proximal humeral fractures were treated with reverse total shoulder arthroplasty.There were 5 males and 7 females with an average age of 70.2 years old(ranged from 63 to 81 years old)and an average course of 12.3 months(ranged from 9 to 18 months).VAS score was used to evaluate the degree of pain relief of shoulder joint,Constant-Murley score was used to evaluate the improvement of shoulder joint function and observe the complications during and after operation.Results:All the 12 patients were followed up with an average duration of 22.3 months(ranged from 15 to 56 months).At the latest follow-up,the VAS score was 1.9±1.4,and Constant-Murley score was 83.4±8.4.Among them,shoulder joint flexion was(92.5±7.7)°,abduction was(90.4±14.3)°,external rotation was(31.9±10.0)°,and internal rotation was(58.9±13.1)°.There was statistical significance before and after treatment(P<0.05).There were 2 cases with glenoid notch.The imaging findings were gradeⅠand gradeⅡrespectively.No loosening was found during follow-up.No infection,acromial fracture,prosthesis loosening,axillary nerve injury and other complications occurred.Conclusion:Reverse total shoulder arthroplasty in treating old proximal humeral fractures in elderly patients can achieve satisfactory results,however,indications and complications should be noted.