目的:反向全肩关节置换术(RSA)彻底改变了老年患者肱骨近端骨折(PHF)的治疗方法。关于老年患者术后康复的管理很少或没有共识。与从结节巩固开始到D30的康复相比,从D1的早期康复可以获得更好的功能效果。
方法:对94例接受PHF手术的患者进行回顾性评估,至少进行2年的放射临床随访。临床评估包括迁移率和四个功能评分:ASES,快速DASH,总常数,加权常数。对前肩X线进行放射学评估,并评估结节的固结。
结果:平均随访45±19个月(24-88个月)。早期康复与更好的恒定评分显着相关(71.1±17.2vs.56.4±15.8;p<0.001),调整后的Constant评分更好(92.4±14.2vs.80.3±19.5;p<0.001),更好的快速DASH(22.8±19.8vs.36.7±21.3;p<0.01),更好的ASES(78.6±20.2vs.63±22;p<0.001)。
结论:在创伤学中,RSA的功能结果似乎与结节愈合无关,但与康复无关,以限制手术后肩关节的僵硬。早期康复与更好的临床和功能结果有关,独立于结节结合。
方法:3,对照病例研究。
OBJECTIVE: Reverse total shoulder arthroplasty (RSA) has revolutionized the management of proximal humerus fractures (PHF) in the elderly patients. There is few or no consensus regarding to management of postoperative rehabilitation in elderly patients. An early rehabilitation from D1 allowed better functional results compared to rehabilitation started to D30 independently from tuberosities consolidation.
METHODS: 94 patients operated on for PHF were evaluated retrospectively, with a minimum radio-clinical follow-up of 2 years. Clinical evaluation included mobilities and four functional scores: ASES, quick DASH, gross constant, weighted constant. Radiological evaluation was performed on a frontal shoulder X-ray with evaluation of tuberosities\' consolidation.
RESULTS: The mean follow-up was 45 ± 19 months (24-88 months). Early rehabilitation was significantly associated with a better Constant Score (71.1 ± 17.2 vs. 56.4 ± 15.8; p < 0.001), better adjusted Constant score (92.4 ± 14.2 vs. 80.3 ± 19.5; p < 0.001), better quick DASH (22.8 ± 19.8 vs. 36.7 ± 21.3; p < 0.01), better ASES (78.6 ± 20.2 vs. 63 ± 22; p < 0.001).
CONCLUSIONS: In traumatology, functional result of RSA seems not related in tuberosities\' union but in rehabilitation in order to limit postoperative stiffness of operated shoulder. An early rehabilitation is related with better clinical and functional results, independently of tuberosities\' union.
METHODS: 3, control-case study.