Parçalı proksimal humerus kırıklarının tedavisinde çimentolu ile çimentosuz hemiartroplasti sonuçlarının karşılaştırılması
Abstract
Amaç: Bu çalışmamızda parçalı proksimal humerus kırığı sonrasında
hemiartroplasti yapılan ileri yaş hastalarda çimentolu ve çimentosuz
uygulamalarımızın sonuçlarını karşılaştırmayı amaçladık.
Gereç ve Yöntem: 2008 ile 2014 yılları arasında, parçalı
proksimal humerus kırığı nedeniyle hemiartroplasti yapılan hastalar iki
üniversite hastanesinin bilgi sistemi kullanılarak retrospektif olarak
araştırıldı ve en az 2 yıllık takibi olan hastalar çalışmaya alındı. Son
takiplerinde muayene bilgileri olmayan, telefon ile ulaşılamayan ve patolojik
veya açık kırığı olan hastalar değerlendirmeye alınmadı. Hastaların demografik
bilgileri, kırık tipi, son takipte fonksiyonel sonuç, son takipte vizüel analog
skala skoru ve ameliyatından memnuniyeti, son takipte radyolojik değerlendirme,
ortalama takip süresi ve komplikasyonlar çimentolu ile çimentosuz uygulamalarda
karşılaştırılarak not edildi.
Bulgular: Çalışmamızın kriterlerini karşılayan toplam 22 hasta (12 erkek, 10
kadın)(ortalama yaş: 76,4 yıl, aralık: 67-88)
çalışmaya dahil edildi. 8 hastada çimentosuz, 14 hastada ise çimentolu
hemiartroplasti yapılmış ve ortalama takip süresi 38 ay idi. Ortalama öne
elevasyon, eksternal rotasyon ve internal rotasyon derecesi çimentosuz
hemiartroplasti yapılan hastalarda daha iyi olmakla beraber her iki grup
arasında fonksiyonel açıdan anlamlı fark bulunamadı. Yine çimentosuz
hemiartroplasti gurubunda ortama vizüel analog skala skoru 0,87±1,12 iken
çimentolu grupta ortalama vizüel analog skala skoru 1,28±0,91 idi ve anlamlı
bir fark bulunamadı (p=0,33). Radyolojik değerlendirmede gruplar arasında
anlamlı fark yoktu. Çimentolu ve çimentosuz hemiartroplasti yapılan hasta
gruplarında 1’er hastada periprostetik kırık görülürken, çimentosuz grubunda 1
hastanın omuzunda sıkılık, çimentolu grubunda ise yine 1 hastada derin doku
enfeksiyonu saptandı.
Sonuç: Proksimal humerus kırığı sonrası hemiartroplasti yapılan
hastalarımızda çimentolu ve çimentosuz uygulamalarımızın fonksiyonel ve
radyolojik sonuçları en az 2 yıllık takiplerinde benzer olarak
bulunmuştur.
References
- 1. Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18(3 suppl):209S–213S
- 2. Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res. 2012 Dec;470(12):3483-91. doi: 10.1007/s11999-012-2531-0
- 3. Schai P, Imhoff A, Preiss S. Comminuted humeral head fractures: a multicenter analysis. J Shoulder Elbow Surg. 1995;4: 319–330
- 4. Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925
- 5. Richard B. Jones, M.D. Hemiarthroplasty for Proximal Humeral Fracture. Bulletin of the Hospital for Joint Diseases 2013;71(Suppl 2):S60-3
- 6. Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):612-21
- 7. Maier D, Jaeger M, Izadpanah K, Strohm P, Suedkamp N. Proximal humeral fracture treatment in adults. Bone Joint Surg Am. 2014 Feb 5;96(3):251-61. doi: 10.2106/JBJS.L.01293
- 8. Neer CS 2nd. Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077– 1089
- 9. Boileau P, Winter M, Cikes A, Han Y, Carles M, Walch G, Schwartz DG. Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elbow Surg. 2013 Nov;22(11):1495-506. doi: 10.1016/j.jse.2013.04.018
- 10. Hadnis J, Huang T, Watts A, Krishnan J, Bain GI. Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? a systematic review. Bone Joint J. 2016 Jan;98-B(1):65-74. doi: 10.1302/0301-620X.98B1.36336
- 11. Litchfield RB, McKee MD, Balyk R, Mandel S, Holtby R, Hollinshead R, Drosdowech D, Wambolt SE, Griffin SH, McCormack R. Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project. J Shoulder Elbow Surg. 2011 Jun;20(4):529-36. doi: 10.1016/j.jse.2011.01.041
- 12. Sanchez-Sotelo J, O’Driscoll SW, Torchia ME, Cofield RH, Rowland CM. Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg. 2001. 10:526–53
- 13. Torrens C, Martínez-Díaz S, Ruiz A, Gines A, Cáceres E. Assessment of radiolucent lines in cemented shoulder hemi-arthroplasties: study of concordance and reproducibility. Int Orthop. 2009 Feb;33(1):165-9. Epub 2007 Oct 17
- 14. Rahme H, Mattsson P, Wikblad L, Larsson S. Cement and press-fit humeral stem fixation provides similar results in rheumatoid patients. Clin Orthop Relat Res. 2006 Jul;448:28-32
- 15. Phadnis J, Huang T, Watts A, Krishnan J, Bain GI. Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? a systematic review. Bone Joint J. 2016 Jan;98-B(1):65-74. doi: 10.1302/0301-620X.98B1.36336
- 16. Raiss P, Edwards TB, Deutsch A, Shah A, Bruckner T, Loew M, Boileau P, Walch G. Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014 Apr 2;96(7):e54. doi: 10.2106/JBJS.M.00378
Comparison of cemented and uncemented hemiarthroplasty results in the treatment of comminuted displaced proximal humeral fractures
Abstract
Aim: In this study, we aimed to compare the results
of cemented and uncemented hemiarthroplasty results in elderly patients for the
treatment of comminuted proximal humerus fractures.
Material
and Method: Between 2008 and 2014, patients who
underwent hemiarthroplasty due to comminuted
proximal humerus fracture were retrospectively investigated using the data
system of two university hospitals. Patients who were followed for at least 2
years were included. Demographic information of the patients, fracture type, functional
results at final follow-up, visual analog scale score and satisfaction status,
radiological results, mean follow-up time and complications were noted.
Results:
A total of 22 patients (12 males, 10 females) (mean age: 76.4 years, range:
67-88)(8 cemented hemiarthroplasty, 14 uncemented hemiarthroplasty) were
included. The mean follow-up time was 38 months. Although the mean forward
elevation, external rotation and internal rotation were better in patients who
underwent uncemented hemiarthroplasty, no significant difference was found
between the two groups. The mean visual analog scale score in uncemented hemiarthroplasty
group was 0.87 ± 1.12, whereas the mean visual analog scale score in cemented
group was 1.28 ± 0.91 and no significant difference was found (p = 0.33). At radiologic
evaluation, no significant difference was found. Periprosthetic fracture was
seen in 1 patient of both groups. We have seen 1 shoulder stiffness in
uncemented group and 1 deep tissue infection in cemented hemiarthroplasty group.
Conclusion:
The functional and radiological results of our cemented and uncemented HA patients
were similar for the treatment of comminuted proximal humerus fractures in at
least 2 years follow-up.
References
- 1. Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18(3 suppl):209S–213S
- 2. Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res. 2012 Dec;470(12):3483-91. doi: 10.1007/s11999-012-2531-0
- 3. Schai P, Imhoff A, Preiss S. Comminuted humeral head fractures: a multicenter analysis. J Shoulder Elbow Surg. 1995;4: 319–330
- 4. Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925
- 5. Richard B. Jones, M.D. Hemiarthroplasty for Proximal Humeral Fracture. Bulletin of the Hospital for Joint Diseases 2013;71(Suppl 2):S60-3
- 6. Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):612-21
- 7. Maier D, Jaeger M, Izadpanah K, Strohm P, Suedkamp N. Proximal humeral fracture treatment in adults. Bone Joint Surg Am. 2014 Feb 5;96(3):251-61. doi: 10.2106/JBJS.L.01293
- 8. Neer CS 2nd. Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077– 1089
- 9. Boileau P, Winter M, Cikes A, Han Y, Carles M, Walch G, Schwartz DG. Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elbow Surg. 2013 Nov;22(11):1495-506. doi: 10.1016/j.jse.2013.04.018
- 10. Hadnis J, Huang T, Watts A, Krishnan J, Bain GI. Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? a systematic review. Bone Joint J. 2016 Jan;98-B(1):65-74. doi: 10.1302/0301-620X.98B1.36336
- 11. Litchfield RB, McKee MD, Balyk R, Mandel S, Holtby R, Hollinshead R, Drosdowech D, Wambolt SE, Griffin SH, McCormack R. Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project. J Shoulder Elbow Surg. 2011 Jun;20(4):529-36. doi: 10.1016/j.jse.2011.01.041
- 12. Sanchez-Sotelo J, O’Driscoll SW, Torchia ME, Cofield RH, Rowland CM. Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg. 2001. 10:526–53
- 13. Torrens C, Martínez-Díaz S, Ruiz A, Gines A, Cáceres E. Assessment of radiolucent lines in cemented shoulder hemi-arthroplasties: study of concordance and reproducibility. Int Orthop. 2009 Feb;33(1):165-9. Epub 2007 Oct 17
- 14. Rahme H, Mattsson P, Wikblad L, Larsson S. Cement and press-fit humeral stem fixation provides similar results in rheumatoid patients. Clin Orthop Relat Res. 2006 Jul;448:28-32
- 15. Phadnis J, Huang T, Watts A, Krishnan J, Bain GI. Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? a systematic review. Bone Joint J. 2016 Jan;98-B(1):65-74. doi: 10.1302/0301-620X.98B1.36336
- 16. Raiss P, Edwards TB, Deutsch A, Shah A, Bruckner T, Loew M, Boileau P, Walch G. Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014 Apr 2;96(7):e54. doi: 10.2106/JBJS.M.00378
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original article |
| Authors | |
| Publication Date | September 30, 2018 |
| Published in Issue | Year 2018 Volume: 10 Issue: 3 |
e-ISSN: 2548-0251
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