反肩置换在老年肱骨近端内固定失败翻修术中的疗效观察

Clinical outcomes of reverse shoulder arthroplasty for the treatment of failed fixation of proximal humeral fracrtures in the elderly patients

目的:探讨反肩置换术在老年肱骨近端骨折内固定失败后翻修中的应用价值和效果。方法:回顾性分析2014年5月至2020年3月肱骨近端骨折内固定失败的患者8例,其中男3例,女5例;年龄65~75岁。8例均行反式肩关节置换术,病程8~16个月。记录并比较手术前和末次随访的关节活动度(range of motion,ROM)、加州大学(University of California at Los Angeles,UCLA)肩关节评分、肩关节视觉模拟评分(visual analogue scale,VAS)、焦虑自评量表(self-rating anxiety scale,SAS)评分、肩关节功能Constant-Murley评分,并分析手术并发症情况。结果:术后8例均获得随访,时间16~28个月。患肩关节活动度(前屈、外旋、外展、内旋)术后明显改善,术后VAS、SAS和UCLA评分也得到改善。肩关节功能Constant-Murley评分中末次随访疼痛、日常活动、活动范围、力量测试评分比术前均有明显提升,且总分比术前提高。1例发生肩胛盂切迹,影像学显示分级为1级,其余患者未发生相关特异性和非特异性并发症。结论:反式肩关节置换术用于老年肱骨近端骨折内固定失败,其翻修的临床效果满意,可加速肩关节功能康复,提高生活质量。

Objective To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients.Methods A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020,including 3 males and 5 females,aged from 65 to 75 years old.All 8 patients underwent reverse total shoulder arthroplasty,and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months.Range of motion(ROM),University of California at Los Angeles(UCLA)shoulder score,visual analogue scale(VAS),self-rating anxiety scale(SAS),and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up.Complications relating to the surgery were recorded.Results All 8 patients successfully followed up.The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months.The range of motion(forward flexion,external rotation,abduction and internal rotation)of the affected shoulder was significantly improved after surgery,and the post-operative VAS,SAS and UCLA scores were also significantly improved.For the Constant-Murley score of shoulder joint function,the total scores and the subscores of pain,daily activities,range of motion and strength test at the last follow-up were all significantly improved.Scapular glenoid notch was observed in patient,which was evaluated as grade 1 on imaging.All the other patients did not develop specific or non-specific complications.Conclusion Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures.It has shown satisfactory clinical outcomes,accelerating the rehabilitation of shoulder function and improving the quality of life.