Comparison of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part fractures of proximal humeral in the elderly
10.3760/cma.j.cn121113-20211019-00604
- VernacularTitle:反肩与半肩关节置换术治疗老年肱骨近端三或四部分骨折的临床疗效比较
- Author:
Fei DAI
1
;
Jingming DONG
;
Jinsong YANG
;
Qing ZHANG
;
Yiping LI
;
Ming XIANG
Author Information
1. 四川省骨科医院上肢科，成都 610041
- Keywords:
Aged;
Shoulder fractures;
Arthroplasty, replacement, shoulder
- From:
Chinese Journal of Orthopaedics
2022;42(4):204-212
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures in the elderly.Methods:The clinical data of 58 elderly patients with three- or four-part proximal humeral fractures treated with hemiarthroplasty or reverse shoulder arthroplasty from June 2014 to June 2020 were retrospectively analyzed. Among them, 46 cases were from Sichuan Provincial Orthopaedic Hospital (22 cases of hemiarthroplasty and 24 cases of reverse shoulder arthroplasty), and 12 cases were from Tianjin Hospital (5 cases of hemiarthroplasty and 7 cases of reverse shoulder arthroplasty). In the hemiarthroplasty group, there were 27 patients, including 7 males and 20 females, with an average age of 70.29±6.81 years (range, 61-87 years), and there were 10 cases of 3-part fractures and 17 cases of 4-part fractures. In the reverse shoulder arthroplasty group, including 9 males and 22 females, with an average age of 75.06 ±4.25 years (range, 67-86 years), and there were 9 cases of 3-part fractures and 22 cases of 4-part fractures. The postoperative efficacy evaluation indexes included visual analogue scale (VAS), range of motion (ROM), prosthesis upward displacement, healing of greater tuberosity, scapular glenoid notch, American Shoulder and Elbow Surgeons (ASES) and Constant-Murley score.Results:The average follow-up was 50.63±16.02 months (range, 24-75 months) in the hemiarthroplasty group and 28.32±11.93 months (range, 14-56 months) in the reverse shoulder arthroplasty group. The anterior elevation in the reverse shoulder arthroplasty group was 118.22°±27.22°, and those in the hemiarthroplasty group was 102.77°±25.88°, which was significant difference ( t=2.21, P=0.032); the results of external rotation (ER) and internal rotation (IR) in two groups were similar, and no significant difference (ER: t=0.57, P=0.616; IR: χ 2=2.61, P=0.273); the average Constant-Murley and ASES in the reverse shoulder arthroplasty group were significantly better than those in the hemiarthroplasty group ( P=0.019 and 0.018); the complication rates of hemiarthroplasty group and reverse shoulder arthroplasty group were 37% (10/27) and 13% (4/31), respectively (χ 2=4.59, P=0.032). In the hemiarthroplasty group, 6 patients had upward movements of the prosthesis and 2 patients had wear of the glenoid side; notching (sirveaux grade 1) was noted in 1 patient in the reverse shoulder arthroplasty group. Conclusion:In the treatment of three- or four-part proximal humeral fractures in the elderly, reverse shoulder arthroplasty achieves significantly better functional results compared to hemiarthroplasty.
