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Abstract：
BACKGROUND: Reverse shoulder arthroplasty (RSA) is a frequently used therapy for complex proximal humeral fractures and posttraumatic disorders. The present study\'s purpose was to assess the clinical and radiological outcome of primary and secondary RSA, and to analyze the impact of refixation of the greater tuberosity (GT).
METHODS: 28 patients with primary fracture RSA and 18 patients with RSA due to posttraumatic disorders were examined with a mean clinical follow-up of 2.5 ± 1.73 years. Operative details and radiographs were retrospectively reviewed. Additional analyses were performed for healed and non-healed GT in primary RSA.
RESULTS: Patients with fracture RSA had higher Constant-Murley score (CMS) than secondary RSA without reaching significance (p = 0.104). No significant difference was present for the quality of life measured by the Short Form 36 (SF 36) and the range of motion. In primary RSA, 78.6% GT healed anatomically. Compared to non-healed GT, patients with healed GT had a significantly higher CMS (p = 0.011), external rotation (p = 0.026) and forward flexion (p = 0.083), whereas DASH score was lower without a significant difference (p = 0.268). SF 36 showed no significant difference. Patients with healed GT had a more neutral glenoid version (p = 0.009).
CONCLUSIONS: Superior range of motion and clinical outcome scores were present for anatomically healed GT. Therefore, refixation of the tuberosities is recommended. Secondary RSA can result in inferior results compared to primary RSA, so patients need to be adequately informed.
METHODS: 28 patients with primary fracture RSA and 18 patients with RSA due to posttraumatic disorders were examined with a mean clinical follow-up of 2.5 ± 1.73 years. Operative details and radiographs were retrospectively reviewed. Additional analyses were performed for healed and non-healed GT in primary RSA.
RESULTS: Patients with fracture RSA had higher Constant-Murley score (CMS) than secondary RSA without reaching significance (p = 0.104). No significant difference was present for the quality of life measured by the Short Form 36 (SF 36) and the range of motion. In primary RSA, 78.6% GT healed anatomically. Compared to non-healed GT, patients with healed GT had a significantly higher CMS (p = 0.011), external rotation (p = 0.026) and forward flexion (p = 0.083), whereas DASH score was lower without a significant difference (p = 0.268). SF 36 showed no significant difference. Patients with healed GT had a more neutral glenoid version (p = 0.009).
CONCLUSIONS: Superior range of motion and clinical outcome scores were present for anatomically healed GT. Therefore, refixation of the tuberosities is recommended. Secondary RSA can result in inferior results compared to primary RSA, so patients need to be adequately informed.
摘要：
背景：反向肩关节成形术（RSA）是复杂肱骨近端骨折和创伤后疾病的常用疗法。本研究的目的是评估原发性和继发性RSA的临床和放射学结果，并分析大结节(GT)再固定的影响。
方法：对28例原发性骨折RSA患者和18例因创伤后疾病引起的RSA患者进行了检查，平均临床随访时间为2.5±1.73年。回顾性审查了手术细节和X光片。对原发性RSA中已治愈和未治愈的GT进行了其他分析。
结果：骨折RSA患者的Constant-Murley评分（CMS）高于继发性RSA，但无显著性意义（p=0.104）。通过简短表格36（SF36）和活动范围测量的生活质量没有显着差异。在主RSA中，78.6%GT解剖愈合。与未愈合的GT相比，治愈的GT患者的CMS明显较高（p=0.011），外旋（p=0.026）和前屈（p=0.083），而DASH评分较低，无显著性差异(p=0.268)。SF一36无明显差别。患有治愈的GT的患者具有更中性的关节盂版本（p=0.009）。
结论：对于解剖学治愈的GT，存在较好的运动范围和临床结果评分。因此,建议重新固定结节。与主要RSA相比，次要RSA可能导致较差的结果，所以患者需要充分了解。
方法：对28例原发性骨折RSA患者和18例因创伤后疾病引起的RSA患者进行了检查，平均临床随访时间为2.5±1.73年。回顾性审查了手术细节和X光片。对原发性RSA中已治愈和未治愈的GT进行了其他分析。
结果：骨折RSA患者的Constant-Murley评分（CMS）高于继发性RSA，但无显著性意义（p=0.104）。通过简短表格36（SF36）和活动范围测量的生活质量没有显着差异。在主RSA中，78.6%GT解剖愈合。与未愈合的GT相比，治愈的GT患者的CMS明显较高（p=0.011），外旋（p=0.026）和前屈（p=0.083），而DASH评分较低，无显著性差异(p=0.268)。SF一36无明显差别。患有治愈的GT的患者具有更中性的关节盂版本（p=0.009）。
结论：对于解剖学治愈的GT，存在较好的运动范围和临床结果评分。因此,建议重新固定结节。与主要RSA相比，次要RSA可能导致较差的结果，所以患者需要充分了解。
