反肩关节置换治疗肱骨近端骨折的并发症:假体周围骨吸收和无菌性假体松动

Complications of reverse shoulder arthroplasty for proximal humeral fractures:periprosthetic bone resorption and aseptic prosthesis loosening

背景:肱骨近端骨折是老年骨质疏松人群的常见病。对于粉碎的肱骨近端骨折伴或不伴脱位患者,越来越多学者倾向于反肩关节置换治疗,但假体周围骨吸收、无菌性假体松动是不可忽视的并发症。目的:综述肱骨近端骨折者反肩关节置换后出现假体周围骨吸收和无菌性假体松动的相关研究进展,并分析其影响因素。方法:以“Proximal humeral fracture,Reverse shoulder arthroplasty,complication,osteolysis,aseptic loosening”为英文检索词,以“肱骨近端骨折、反肩关节置换、并发症、假体周围骨吸收、无菌性假体松动”为中文检索词,在PubMed、Web of Science和中国知网数据库检索假体无菌性松动的相关研究,检索时间为2000年12月至2021年7月,最终纳入53篇文献进行综述。结果与结论:①反肩关节置换后发生假体周围骨吸收及假体松动平均时间约为置换后6年,按假体部件分类主要有假体柄和假体基座周围的骨吸收、松动。②反肩关节置换后由于假体周围磨损颗粒刺激、假体周围应力及假体周围炎性反应,导致发生假体周围骨吸收、无菌性假体松动。③反肩关节置换后,假体柄周围骨吸收、松动的发生率明显高于假体基座,然而假体基座周围发生骨吸收、松动多需要再手术或翻修手术。④肱骨近端骨折者反肩关节置换后出现假体周围骨吸收和无菌性假体松动的影响因素主要包括患者因素(包括年龄、性别和基础病变情况等)、医师因素(包括假体选择、假体固定方式、安放角度、术后针对性抗骨质疏松和康复方案等)。⑤针对不同的患者选择合适的假体、进行针对性的手术操作、置换后个体化康复方案及针对性干预措施,可在未来减少假体周围骨吸收和假体松动的发生率。

BACKGROUND:Proximal humeral fracture is a common disease in older adults with osteoporosis.Increasing scholars prefer reverse shoulder arthroplasty in the treatment of comminuted proximal humeral fractures with or without dislocation of the shoulder.However,periprosthetic bone resorption and aseptic prosthesis loosening cannot be ignored.OBJECTIVE:To review the research progress in periprosthetic bone resorption and aseptic prosthesis loosening in patients with proximal humeral fractures after reverse shoulder arthroplasty,and to analyze the influencing factors.METHODS:PubMed,Web of Science,and CNKI databases were searched for articles related to aseptic prosthesis loosening,which were published from December 2000 and July 2021.The search terms were“proximal humeral fracture,reverse shoulder arthroplasty,complication,osteolysis,and aseptic loosening”in English and Chinese,respectively.Finally,53 articles were included for review.RESULTS AND CONCLUSION:The average time for periprosthetic bone resorption and loosening following reverse shoulder arthroplasty is about 6 years.According to the classification of prosthetic components,periprosthetic bone resorption and loosening can be mainly divided into prosthesis stem and prosthesis base plate types.After reverse shoulder arthroplasty,periprosthetic bone absorption and aseptic prosthesis loosening result from the stimulation of periprosthetic wear particles,periprosthetic stress,and periprosthetic inflammation.After reverse shoulder arthroplasty,the incidence of bone resorption and loosening around the prosthesis stem is higher than that around the prosthesis base plate.However,the bone resorption and loosening around the prosthesis base plate often require reoperation or revision surgery.Patient factors(including patient age,gender,underlying disease conditions,etc.)and physician factors(including prosthesis selection,prosthesis fixation method,placement angle,postoperative targeted anti-osteoporosis,rehabilitation program,etc.)can lead to periprosthetic bone resorption or aseptic loosening after reverse shoulder arthroplasty of proximal humeral fractures.There are four methods to reduce the incidence of periprosthetic bone resorption and prosthesis loosening in the future:selecting the appropriate prosthesis for different patients,performing targeted surgical operations,individualized rehabilitation programs after replacement,and targeted intervention measures after replacement.