背景:肩峰和肩胛骨骨折是反向全肩关节置换术(RTSA)后常见的并发症。关于这些骨折的治疗结果的信息有限。因此,这项研究的目的是比较手术和保守治疗肩峰或肩胛骨骨折患者的临床效果。
方法:在1999年至2016年期间,我们机构共进行了1146项RTSA。在23名患者(2%)中,我们发现了肩峰骨折,在7例(0.6%)中,术后出现肩胛骨骨折。这些病人中,7例(23%)接受切开复位内固定治疗,23例(77%)接受保守治疗。我们比较了手术与手术的结果。保守治疗评估Constant评分(CS),运动范围,和主观肩值(SSV)。骨折由Crosby系统分类。影像学评估包括测量治愈率,时间愈合,以及骨折前后以及治疗后肩峰的移位。
结果:手术和保守治疗之间无统计学差异。手术组术前平均CS32分,术后改善至45分,而保守组患者为35分,最后随访时提高至61分.手术组的平均SSV从20分提高到50分,保守组的平均SSV从22分提高到58分。平均主动屈曲从59°变为75°,平均外展从68°到67°,手术组从25°旋转到13°,从75°旋转到91°,67°到92°,保守组28°至24°。
结论:在我们的研究中,手术治疗并不优于保守治疗,对于CS来说都不是,SSV,或运动范围。两种治疗形式,然而,结果不如先前报道的RTSA结果,但没有术后肩峰骨折。在开发出更好的手术方法之前,肩峰骨折的保守治疗可能是RTSA术后肩峰骨折更好的治疗选择.
BACKGROUND: Acromial and scapular spine fractures are common complications after reverse total shoulder arthroplasty (RTSA). There is limited information on the treatment outcome of these fractures. Therefore, the purpose of this study was to compare the clinical outcome of operative and conservative treatment of patients with acromial or scapular spine fractures.
METHODS: A total of 1146 RTSAs were performed in our institution between 1999 and 2016. In 23 patients (2%), we identified an acromial fracture, and in 7 cases (0.6%), a scapular spine fracture in the postoperative course. Of those patients, 7 patients (23%) were treated with open reduction and internal fixation and 23 (77%) were treated conservatively. We compared the outcome of operative vs. conservative treatment assessing the Constant score (CS), range of motion, and subjective shoulder value (SSV). Fractures were classified by the system of Crosby. Radiographic assessment consisted of measuring the healing rate, time to heal, and the displacement of the acromion before and immediately after the fracture as well as after treatment.
RESULTS: There were no statistically significant differences between operative and conservative treatment. The mean preoperative CS in the operative group was 32 points and improved to 45 points after surgery, whereas it was 35 points in the conservative group and improved to 61 points at the final follow-up. The mean SSV improved from 20 to 50 points in the operative group and from 22 to 58 points in the conservative group. Mean active flexion changed from 59° to 75°, mean abduction from 68° to 67°, and external rotation from 25° to 13° in the operative group and from 75° to 91°, 67° to 92°, and 28° to 24° in the conservative group.
CONCLUSIONS: In our study, operative treatment was not superior to conservative treatment, neither for CS, SSV, or range of motion. Both treatment forms, however, resulted in inferior results to those previously reported for RTSA without postoperative acromion fractures. Before better surgical methods have been developed, conservative treatment of acromial fractures may be the better treatment option for acromial fractures after RTSA.