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Omuz Hemiartroplastisinde Proksimal Humerus Restorasyonunun Radyolojik Analizi ve Fonksiyonel Sonuçlar

Yıl 2021, Cilt: 8 Sayı: 1, 5 - 12, 30.04.2021
https://doi.org/10.47572/muskutd.811424

Öz

Glenohumeral ofset, subakromiyal boşluk, tüberküllerinvertikal ve horizontal plandaki ölçümleri ve yağlıinfiltrasyonun evreleri gibi radyolojik parametreler, omuz artroplastisinde, proksimalhumerusun restorasyonu incelenirken kullanılır.Bu çalışma, hemiartroplasti sonrası hangi radyolojik parametrelerin fonksiyonel sonuçlarla daha uyumlu olduğunu belirlemek için tasarlanmıştır. 2002-2010 yılları arasında proksimalhumerus kırıkları nedeniyle hemiartroplasti ile tedavi edilen ve postoperatif bilgisayarlı tomografi (BT) taramaları olan 25 hasta değerlendirildi. Protez başın son pozisyonu, tüberküllerin restorasyonu ve supraspinatus kasının yağlı infiltrasyonuradyolojik olarak analiz edildi. Fonksiyonel değerlendirmede, Amerikan Omuz ve Dirsek Topluluğu (ASES) Skoru, Constant-Murley skoru, DASH (kol,omuz ve elkısıtlılık indeksi) skoru kullanılmıştır. Yaş aralıkları 52-84 yaş arası değişen hastaların ortalama ASES, Constant-Murley ve DASH indeks skorları sırasıyla 70, 66 ve 23 idi. Normal retroversiyona sahip protezi olan hasta grubu daha yüksek Constant-Murley ve daha düşük DASH indeks skorlarına sahipti (p<0.05). BT taramalarında 0 ila 5 mm horizontalmalpozisyonu bulunan grup daha iyi klinik sonuçlara sahipti (p<0.05).Evre 0 yağlı infiltrasyonbulunan hasta grubunda daha iyi klinik sonuçlar not edildi (p<0.05). Hemiartroplasti, proksimalhumerus kırıklarında önemli bir tedavi seçeneği olmaya devam etmektedir. Proksimalhumerus anatomisine daha yakın restorasyon elde etmek ile birlikte yağlı infiltrasyonunevresi, başarılı bir fonksiyonel sonuçta önemli bir rol oynamaktadır. 

Kaynakça

  • 1. Fenichel I, Oran A, Burstein G, Perry M. Percutaneous pinning using threaded pins as a treatment option for unstable two and three part fractures of a proximal humerus: A retrospective study. Int Orthop. 2006;30(3):153–7.
  • 2. Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults: A systematic review of management. Injury. 2001;32:363–72.
  • 3. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–7.
  • 4. Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proximal humeral fractures: A systematic review of treatment modalities. J Shoulder Elbow Surg. 2008;17(1):42–54.
  • 5. Moen TC, Bigliani LU. Hemiarthroplasty for four-part fractures of the proximal humerus. Oper Tech Orthop. 2011;21:94–100.
  • 6. Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85(7):1215–23.
  • 7. Huffman GR, Itamura JM, McGarry MH, Gililland J, Lee TQ. Neer Award 2006: Biomechanical assessment of inferior tuberosity placement during hemiarthroplasty for four-part proximal humeral fractures. J Shoulder Elbow Surg. 2008;17(2):189–96.
  • 8. Hempfing A, Leunig M, Ballmer FT, Hertel R. Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures. J Shoulder Elbow Surg. 2001;10:460–3.
  • 9. Kralinger F, Schwaiger R, Wambacher M, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br. 2004;86:217–9.
  • 10. Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE III. Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures. J Shoulder Elbow Surg. 2001;10:321–6.
  • 11. Gerber C, Yian EH, Pfirrmann CA, Zumstein MA, Werner CM. Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am. 2005;87:1739–45.
  • 12. Greiner SH, Diederichs G, Kroning I, Scheibel M, Perka C. Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2009;18(3):431–6.
  • 13. Demirhan M. Factors affecting the results of hemiarthroplasty for proximal humerus fractures. Acta Orthop Traumatol Turc. 2000;34:463–74.
  • 14. Goutallier D, Postel JM, Bernageau J, Lavau L. Fatty muscle degeneration in cuff ruptures pre and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.
  • 15. Torrens C, Corrales M, Melendo E, Solano A, Rodríguez-Baeza A, Cáceres E. The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture. J Shoulder Elbow Surg. 2008;17(6):947–50.
  • 16. Bigliani LU, McCluskey GM III. Prosthetic replacement in acute fractures of the proximal humerus. Semin Arthroplasty .1990;1(2):129–37.
  • 17. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg A. 2009;91(7):1689–97.
  • 18. Bigliani LU. Proximal humeral arthroplasty for acute fractures. In: Craig EV, ed. Master Techniques in Orthopaedic Surgery: The Shoulder. 1995; 259–74. New York: Raven Press.
  • 19. Zukerman J, Cuomo F, Koval K. Proximal humeral replacement for complex fractures, indications, and surgical technique. Instr Course Lect. 1997;64:7–14.
  • 20. Boileau S, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002;11(5):401–12.
  • 21. Gürbüz H, Sekhavat H, Demiral H. Our results of shoulder prosthesis. Acta Orthop Traumatol Turc. 2004;32(2):100–2.
  • 22. Frankle MA, Mighell MA. Techniques and principles of tuberosity fixation for proximal humeral fractures treated with hemiarthroplasty. J Shoulder Elbow Surg. 2004;13(2):239–47.
  • 23. Rietveld AB, Daanen HA, Rozing PM, Obermann WR. The lever arm in glenohumeral abduction after hemiarthroplasty. J Bone Joint Surg Br. 1988;70:561–5.
  • 24. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.
  • 25. Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: Results of a multicenter study with more than five years of followup. J Bone Joint Surg. 2012;94(8):685–93.
  • 26. Gracitelli MEC, Duarte FA, Toffoli RP, Burnato JH. Shoulder arthroplasty in osteoarthritis: Correlation between function and radiographic parameters. Acta Ortop Bras. 2013;21(2):98–102.
  • 27. Reuther F, Muller S, Wahl D. Management of humeral head fractures with a trauma shoulder prosthesis: Correlation between joint function and healing of the tuberosities. Acta Orthop Belg. 2007;73:179–87.
  • 28. Movin T, Sjoden GO, Ahrengart L. Poor function after shoulder replacement in fracture patients. A retrospective evaluation of 29 patients followed for 2-12 years. Acta Orthop Scand. 1998;69:392–6.
  • 29. Du S, Ye J, Chen H, Li X, Lin Q. Interventions for treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials. Int J Surg. 2017;48:240–6.
  • 30. David G, Xavier O , Lauryl D , Choukry D , Philippe V , Pascal B , et al.Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2018;104:759–66.
  • 31. Barco R, Savvidou OD,Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2016;1(3):72–80.

Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty

Yıl 2021, Cilt: 8 Sayı: 1, 5 - 12, 30.04.2021
https://doi.org/10.47572/muskutd.811424

Öz

In shoulder hemiarthroplasty, the glenohumeral offset, subacromial gap, vertical and horizontal measurements of tuberosities, and stage of fatty infiltration are some of the radiological parameters that evaluate the restoration of proximal humerus. This study was designed to determine which radiological parameters are more compatible with functional results after hemiarthroplasty. Twenty-five patients, who were treated between 2002 and 2010 for proximal humerus fractures with hemiarthroplasty and had post-operative computed tomography (CT) scans, were evaluated. The final position of the prosthetic head, tuberculum restoration, and fatty degeneration of the supraspinatus muscle were analysed radiologically. The American Shoulder and Elbow Society (ASES) score, Constant–Murley score, Disabilities of the Arm, Shoulder, and Hand (DASH) index score were used to determine functional performance. The mean ASES, Constant–Murley, and DASH index scores of patients aged 52 to 84 years were 70, 66, and 23, respectively. The patient group with a normal retroverted prothesis had higher Constant–Murley and lower DASH index scores (p<0.05). The group with 0 to 5 mm horizontal malpositioning in CT scans had better clinical outcomes (p<0.05). Better clinical outcomes were noted in the stage 0 fatty infiltration group (p<0.05). Hemiarthroplasty remains an important treatment option in proximal humerus fractures. In collaboration with achieving closer restoration to proximal humerus anatomy, the stage of fatty degeneration plays an important role in a successful functional result.
Keywords:  

Kaynakça

  • 1. Fenichel I, Oran A, Burstein G, Perry M. Percutaneous pinning using threaded pins as a treatment option for unstable two and three part fractures of a proximal humerus: A retrospective study. Int Orthop. 2006;30(3):153–7.
  • 2. Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults: A systematic review of management. Injury. 2001;32:363–72.
  • 3. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–7.
  • 4. Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proximal humeral fractures: A systematic review of treatment modalities. J Shoulder Elbow Surg. 2008;17(1):42–54.
  • 5. Moen TC, Bigliani LU. Hemiarthroplasty for four-part fractures of the proximal humerus. Oper Tech Orthop. 2011;21:94–100.
  • 6. Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85(7):1215–23.
  • 7. Huffman GR, Itamura JM, McGarry MH, Gililland J, Lee TQ. Neer Award 2006: Biomechanical assessment of inferior tuberosity placement during hemiarthroplasty for four-part proximal humeral fractures. J Shoulder Elbow Surg. 2008;17(2):189–96.
  • 8. Hempfing A, Leunig M, Ballmer FT, Hertel R. Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures. J Shoulder Elbow Surg. 2001;10:460–3.
  • 9. Kralinger F, Schwaiger R, Wambacher M, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br. 2004;86:217–9.
  • 10. Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE III. Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures. J Shoulder Elbow Surg. 2001;10:321–6.
  • 11. Gerber C, Yian EH, Pfirrmann CA, Zumstein MA, Werner CM. Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am. 2005;87:1739–45.
  • 12. Greiner SH, Diederichs G, Kroning I, Scheibel M, Perka C. Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2009;18(3):431–6.
  • 13. Demirhan M. Factors affecting the results of hemiarthroplasty for proximal humerus fractures. Acta Orthop Traumatol Turc. 2000;34:463–74.
  • 14. Goutallier D, Postel JM, Bernageau J, Lavau L. Fatty muscle degeneration in cuff ruptures pre and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.
  • 15. Torrens C, Corrales M, Melendo E, Solano A, Rodríguez-Baeza A, Cáceres E. The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture. J Shoulder Elbow Surg. 2008;17(6):947–50.
  • 16. Bigliani LU, McCluskey GM III. Prosthetic replacement in acute fractures of the proximal humerus. Semin Arthroplasty .1990;1(2):129–37.
  • 17. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg A. 2009;91(7):1689–97.
  • 18. Bigliani LU. Proximal humeral arthroplasty for acute fractures. In: Craig EV, ed. Master Techniques in Orthopaedic Surgery: The Shoulder. 1995; 259–74. New York: Raven Press.
  • 19. Zukerman J, Cuomo F, Koval K. Proximal humeral replacement for complex fractures, indications, and surgical technique. Instr Course Lect. 1997;64:7–14.
  • 20. Boileau S, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002;11(5):401–12.
  • 21. Gürbüz H, Sekhavat H, Demiral H. Our results of shoulder prosthesis. Acta Orthop Traumatol Turc. 2004;32(2):100–2.
  • 22. Frankle MA, Mighell MA. Techniques and principles of tuberosity fixation for proximal humeral fractures treated with hemiarthroplasty. J Shoulder Elbow Surg. 2004;13(2):239–47.
  • 23. Rietveld AB, Daanen HA, Rozing PM, Obermann WR. The lever arm in glenohumeral abduction after hemiarthroplasty. J Bone Joint Surg Br. 1988;70:561–5.
  • 24. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.
  • 25. Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: Results of a multicenter study with more than five years of followup. J Bone Joint Surg. 2012;94(8):685–93.
  • 26. Gracitelli MEC, Duarte FA, Toffoli RP, Burnato JH. Shoulder arthroplasty in osteoarthritis: Correlation between function and radiographic parameters. Acta Ortop Bras. 2013;21(2):98–102.
  • 27. Reuther F, Muller S, Wahl D. Management of humeral head fractures with a trauma shoulder prosthesis: Correlation between joint function and healing of the tuberosities. Acta Orthop Belg. 2007;73:179–87.
  • 28. Movin T, Sjoden GO, Ahrengart L. Poor function after shoulder replacement in fracture patients. A retrospective evaluation of 29 patients followed for 2-12 years. Acta Orthop Scand. 1998;69:392–6.
  • 29. Du S, Ye J, Chen H, Li X, Lin Q. Interventions for treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials. Int J Surg. 2017;48:240–6.
  • 30. David G, Xavier O , Lauryl D , Choukry D , Philippe V , Pascal B , et al.Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2018;104:759–66.
  • 31. Barco R, Savvidou OD,Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2016;1(3):72–80.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Onur Gürsan 0000-0002-6356-3834

Mustafa Özkan Bu kişi benim 0000-0003-1097-6608

Ahmet Acan 0000-0001-7116-8773

Yayımlanma Tarihi 30 Nisan 2021
Gönderilme Tarihi 16 Ekim 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 8 Sayı: 1

Kaynak Göster

APA Gürsan, O., Özkan, M., & Acan, A. (2021). Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 8(1), 5-12. https://doi.org/10.47572/muskutd.811424
AMA Gürsan O, Özkan M, Acan A. Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty. MMJ. Nisan 2021;8(1):5-12. doi:10.47572/muskutd.811424
Chicago Gürsan, Onur, Mustafa Özkan, ve Ahmet Acan. “Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8, sy. 1 (Nisan 2021): 5-12. https://doi.org/10.47572/muskutd.811424.
EndNote Gürsan O, Özkan M, Acan A (01 Nisan 2021) Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8 1 5–12.
IEEE O. Gürsan, M. Özkan, ve A. Acan, “Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty”, MMJ, c. 8, sy. 1, ss. 5–12, 2021, doi: 10.47572/muskutd.811424.
ISNAD Gürsan, Onur vd. “Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8/1 (Nisan 2021), 5-12. https://doi.org/10.47572/muskutd.811424.
JAMA Gürsan O, Özkan M, Acan A. Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty. MMJ. 2021;8:5–12.
MLA Gürsan, Onur vd. “Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 8, sy. 1, 2021, ss. 5-12, doi:10.47572/muskutd.811424.
Vancouver Gürsan O, Özkan M, Acan A. Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty. MMJ. 2021;8(1):5-12.