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  • Title: [Application of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humeral fractures].
    Author: Zhang Q, Deng M, Li Y, Zheng J, Yang J, Dai F, Xiang M.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Sep 15; 38(9):1065-1070. PubMed ID: 39300880.
    Abstract:
    OBJECTIVE: To analyze the effectiveness of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humerus fracture. METHODS: A clinical data of 28 patients with fresh proximal humerus fractures, who met the selection criteria and admitted between June 2014 and April 2022, was retrospectively analyzed. There were 7 males and 21 females. Age ranged from 65 to 81 years, with an average of 73.8 years. The causes of injury were 21 cases of fall, 6 cases of traffic accident, and 1 case of falling from height. The time from injury to operation ranged from 5 to 20 days with an average of 9.2 days. There were 8 cases of Neer three-part fracture and 20 cases of four-part fracture. The reverse total shoulder arthroplasty was performed, and the greater and lesser tuberosities were sutered and reconstructed with autogenous bone grafting. After operation, the Constant score, American Society for Shoulder Surgery (ASES) score, and visual analogue scale (VAS) score were used to evaluate shoulder function and pain; and the active range of motion of the shoulder joint was recorded, including flexion, external rotation, and internal rotation. X-ray films were taken to observe the position of prosthesis. According to the evaluation criteria proposed by Boileau, the healing of greater tuberosity was evaluated, and the effectiveness was compared between the patients with healed and non-healed (displacement and absorption) greater tuberosity. RESULTS: All incisions healed by first intention after operation. All patients were followed up 24-106 months, with an average of 60.9 months. At last follow-up, the VAS score of shoulder joint ranged from 0 to 6 (mean, 1.1). The Constant score ranged from 45 to 100 (mean, 80.1). The ASES score ranged from 57 to 100 (mean, 84.7). The active range of motions of shoulder joint were 60°-160° (mean, 118°) in flexion, 0°-50° (mean, 30°) in external rotation, and corresponding to reaching the S 5-T 8 vertebral body level in internal rotation. During follow-up, no shoulder joint re-dislocation or severe shoulder instability occurred, and no revision surgery was performed. X-ray film reexamination showed that there was no loosening of the prosthesis. According to the evaluation criteria proposed by Boileau, the greater tuberosity fused in 22 cases (78.6%), displaced in 3 cases (10.7%), and absorbed in 3 cases (10.7%). The shoulder joint function and pain related evaluation indicators in the healed group were significantly better than those in the non-healed group ( P<0.05). CONCLUSION: Tuberosity suture combined with autogenous bone grafting is a relatively simple procedure that provides a reliable fixation for the anatomic recovery of greater and lesser tuberosities and is beneficial for the recovery of shoulder function in elderly patients with proximal humeral fractures. 目的: 总结老年肱骨近端骨折患者反向全肩关节置换术中采用结节缝合法联合自体骨植骨技术重建固定结节的效果。. 方法: 回顾分析2014年6月—2022年4月收治且符合选择标准的28例新鲜肱骨近端骨折患者临床资料。男7例，女 21 例；年龄 65～81岁，平均73.8岁。致伤原因：摔伤21例，交通事故伤6例，高处坠落伤1例。受伤至手术时间5～20 d，平均9.2 d。骨折分型：Neer三部分骨折8例、四部分骨折20例。采用反向全肩关节置换术治疗，术中使用结节缝合法联合自体骨植骨重建固定大、小结节。术后采用Constant评分、美国肩肘外科协会（ASES）评分、疼痛视觉模拟评分（VAS）评价肩关节功能及疼痛程度，记录肩关节主动前屈上举、外旋和内旋活动度。摄肩部X线片观察假体位置，并根据Boileau提出的评价标准评价大结节愈合情况，比较愈合与未愈合（移位、吸收）患者间疗效差异。. 结果: 术后切口均Ⅰ期愈合。患者均获随访，随访时间24～106个月，平均60.9个月。末次随访时，肩关节疼痛VAS评分0～6分，平均1.1分。肩关节功能Constant评分45～100分，平均80.1分； ASES评分57～100分，平均84.7分。肩关节主动活动度：前屈上举60°～160°，平均118°；外旋0°～50°，平均30°；内旋达S 5～T 8椎体水平。随访期间无肩关节再脱位或严重肩部不稳定发生，无翻修手术。X线片复查示假体位置良好，无假体松动；末次随访时根据Boileau提出的评价标准，大结节愈合22例（78.6%）、移位3例（10.7%）、吸收3例（10.7%）。愈合组患者肩关节功能及疼痛相关评价指标均优于未愈合组，差异有统计学意义（ P<0.05）。. 结论: 老年肱骨近端骨折患者反向全肩关节置换术中，结节缝合法联合自体骨植骨技术能可靠固定大、小结节，为其解剖愈合奠定基础，有利于术后肩部功能恢复。.
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