背景:反向全肩关节置换术(RTSA)已成为复杂肱骨近端骨折(PHF)治疗中越来越流行的治疗策略。然而,对于PHF后RTSA的最佳手术时机尚未达成明确共识,特别是考虑到非手术管理通常是一个可行的选择。因此,本研究的目的是(1)确定最大化RTSA后修正可能性的最佳时间间隔;(2)使用确定的时间间隔确定修正病因的差异.
方法:使用国家行政索赔数据库对2010年至2021年接受PHF指示的RTSA的患者进行了回顾性队列分析。进行层特异性似然比(SSLR)分析,以确定PHF和RTSA之间的数据驱动的时间层次,从而在RTSA的2年内最大化翻修手术的可能性。为了控制混杂因素,进行了多变量回归分析,以确认已确定的数据驱动层与2年翻修率的关联,并比较包括机械松动在内的各种翻修适应症的可能性,位错,假体周围关节感染(PJI),和假体周围骨折(PPF)。
结果:总计,本研究包括11,707例PHF后接受TSA的患者。SSLR分析确定了两个时间类别:从PHF到TSA手术时间的0-6周和7-52周。相对于0-6周队列,7~52周队列在2年内接受翻修手术的可能性更大(OR:1.93,P<0.001).此外,7-52周的队列有明显较高的修正的可能性,表明脱位(OR:2.24,P<0.001),机械松动(OR:1.71,P<0.001),PJI(OR:1.74,P<0.001),和PPF(OR:1.96,P<0.001)。
结论:使用SSLR,我们成功地确定了PHF和RTSA之间的两个数据驱动的时间层次,这使得2年翻修手术的可能性最大化.由于很难确定RTSA或非手术管理最初是否更合适,考虑到这项研究的结果,在不改变与RTSA相关的风险的情况下,进行4~6周非手术治疗的早期试验可能是合适的.
BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment strategy in the management of complex proximal humeral fractures (PHFs). However, no definitive consensus has been reached regarding the optimal surgical timing of RTSA following PHF, particularly considering nonoperative management is often a viable option. Therefore, the aim of this study was (1) to identify optimal timing intervals that maximize the likelihood of revision following RTSA and (2) to determine differences in revision etiologies using the identified timing intervals.
METHODS: A retrospective cohort analysis of patients undergoing PHF-indicated RTSA from 2010 to 2021 was conducted using a national administrative claims database. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven timing strata between PHF and RTSA that maximized the likelihood of revision surgery within 2 years of RTSA. To control for confounders, multivariable regression analysis was conducted to confirm the identified data-driven strata\'s association with 2-year revision rates as well as compare the likelihood of various indications for revision including mechanical loosening, dislocation, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF).
RESULTS: In total, 11,707 patients undergoing TSA following PHF were included in this study. SSLR analysis identified 2 timing categories: 0-6 weeks and 7-52 weeks from the time of PHF to TSA surgery. Relative to the 0-6-week cohort, the 7-52-week cohort was more likely to undergo revision surgery within 2 years (OR 1.93, P < .001). Moreover, the 7-52-week cohort had significantly higher odds of revision indicated for dislocation (OR 2.24, P < .001), mechanical loosening (OR 1.71, P < .001), PJI (OR 1.74, P < .001), and PPF (OR 1.96, P < .001).
CONCLUSIONS: Using SSLR, we were successful in identifying 2 data-driven timing strata between PHF and RTSA that maximized the likelihood of 2-year revision surgery. As it can be difficult to determine whether RTSA or nonoperative management is initially more appropriate, considering the results of this study, an early trial of 4-6 weeks of nonoperative management may be appropriate without altering the risks associated with RTSA.