反肩关节假体置换治疗老年复杂肱骨近端骨折的早期疗效评价

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty

目的评估反肩关节假体置换术一期治疗老年复杂肱骨近端骨折的早期疗效。方法回顾性分析2017年7月至2019年1月采用反肩关节假体置换术治疗43例老年肱骨近端复杂骨折患者资料,男12例,女31例;年龄72岁(范围,66~78岁);均为外伤导致的新鲜闭合性骨折;受伤至手术时间8 d(范围,6~11 d);根据Neer分型,三部分骨折21例(48.8%,21/43),四部分骨折22例(51.2%,22/43)。采用视觉模拟评分(visual analogue scale,VAS)、Neer肩关节置换疗效评价系统以及Constant-Murley肩关节评分等评价术后疗效。结果43例患者均顺利完成手术,手术时间141.3 min(范围,120~170 min),术中失血量407 ml(范围,250~700 ml),术中输血446.5 ml(范围,400~800 ml)。43例患者均获得随访,随访时间10.9个月(范围,6~16个月)。所有患者均在术后7 d内出院,无一例发生伤口相关并发症。43例患者的大、小结节均在8周内完全愈合,至末次随访时,未发生假体松动或脱位。末次随访时肩关节前屈上举133.0°(范围,100°~165°),外旋29.5°(范围,20°~35°),内旋46.7°(范围,30°~60°);VAS评分0.8分(范围,0~3分);Neer评分87分(范围,73~98分),其中优20例(46.5%,20/43),良16例(37.2%,16/43),可7例(16.3%,7/43);Constant-Murley评分88.7分(范围,70~98分)。术后第1天,1例71岁的患者即出现腋神经损伤症状,采用神经营养药物治疗,术后6周复查时症状消失,未影响患者的功能康复锻炼,也未对假体的稳定性造成影响。所有患者随访期间未发现感染、肩峰应力骨折、肩胛骨撞击等并发症。结论采用反肩关节假体置换术一期治疗老年复杂肱骨近端骨折的早期疗效满意。

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed.There were 12 males and 31 females with an average age of 72 years(range,66-78 years).All fractures were fresh and close which caused by trauma.The average time from injury to operation was 8.0 days(range,6-11 days).According to Neer classification,21 cases(48.8%,21/43)were three-part fractures,22 cases(51.2%,22/43)four-part fractures.Visual analogue scale(VAS),Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results.Results All operations were successfully completed.The average operation time was 141.3 minutes(range,120-170 minutes.The mean blood loss was 407 ml(range,250-700 ml)and intraoperative blood transfusion was 446.5 ml(range,400-800 ml).All patients were followed up for 10.9 months(range,6 to 16 months).All patients were discharged within 7 days after operation,and no wounds related complications occurred.The bigger and lesser tuberosities of all patients healed completely within 8 weeks.At the latest follow-up,no loosening or dislocation of prosthesis occurred,and the forward elevation was 133.0°(range,100°-165°);external rotation was 29.5°(range,20°-35°);internal rotation was 46.7°(range,30°-60°).VAS score was 0.8(range,0-3).The Neer score was 87(range,73-98),with 20 cases(46.5%,20/43)excellent,16 cases(37.2%,16/43)good,and 7 cases(16.3%,7/43)fair.Constant-Murley score was 88.7(range,70-98).A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation,which did not affect the functional rehabilitation exercise or the stability of the prosthesis.During the follow-up,no other complications such as infection,acromial stress fracture and scapular notching were found in all patients.Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.