Başarısız İç Fiksasyon Sonrası Proksimal Humerus Kırıklarının Yönetiminde Ters Omuz Artroplastisinin Sonuçları

Yıl 2025, Cilt: 7 Sayı: 2, 271 - 278, 09.05.2025

Oğuzhan Çiçek , Evren Karaali , Osman Ciloglu , Fırat Seyfettinoğlu , Ozhan Pazarcı , Ahmet Can Özsoy

https://doi.org/10.37990/medr.1636986

Öz

Arka Plan: Bu çalışma, başarısız iç fiksasyon nedeniyle revizyon cerrahisi gereken proksimal humerus kırığı hastalarında ters omuz artroplastisinin (RSA) klinik ve fonksiyonel sonuçlarını değerlendirmeyi amaçlamaktadır. Kırık tipi ve revizyon zamanlamasının ameliyat sonrası ağrı, eklem hareket açıklığı ve fonksiyonel skorlar üzerindeki etkisi de incelenmiştir.

Yöntemler: 2017 ile 2020 yılları arasında başarısız iç fiksasyon sonrası RSA uygulanan hastalar üzerinde retrospektif bir analiz gerçekleştirilmiştir. Ameliyat sırasında onarılamaz rotator manşet yırtığı tespit edilen hastalar çalışmaya dahil edilmiştir. Fonksiyonel sonuçlar, Amerikan Omuz ve Dirsek Cerrahları Derneği (ASES) skoru, Constant-Murley skoru, QuickDASH ve Görsel Analog Skalası (VAS) kullanılarak değerlendirilmiştir. Eklem hareket açıklığı (fleksiyon, abduksiyon, internal ve eksternal rotasyon) da incelenmiştir. İstatistiksel karşılaştırmalar kırık tipi (Neer Tip 3 ve Neer Tip 4) ve revizyon süresine göre yapılmıştır.

Bulgular: Neer Tip 4 kırığı olan hastalar, Neer Tip 3 kırığı olanlara kıyasla belirgin şekilde daha kötü fonksiyonel sonuçlara ve daha yüksek ağrı seviyelerine sahipti. Neer Tip 4 hastalarında VAS skoru (3.2±1.8), Neer Tip 3 hastalarına göre (0.9±0.9) daha yüksekti. Constant-Murley skoru Neer Tip 4 hastalarında (50.7±10.4), Neer Tip 3 hastalarında ise (61.8±9.0) olarak bulundu. Daha uzun revizyon süresi, daha kötü fonksiyonel sonuçlar, artan ağrı ve azalan eklem hareket açıklığı ile ilişkiliydi. Fleksiyon (102.9±23.1° vs. 80.0±22.8°) ve abduksiyon (99.4±19.2° vs. 73.3±22.5°), Neer Tip 3 ve Neer Tip 4 kırıkları arasında belirgin farklılık gösterdi. Ancak, RSA ameliyat sonrası tatmin edici ağrı kontrolü sağladı (VAS 1.5±1.5) ve fonksiyonel skorları iyileştirdi (ASES Operasyon Kol Skoru 59.0±21.3).

Sonuç: Ters omuz artroplastisi, başarısız iç fiksasyon sonrası proksimal humerus kırıklarının tedavisinde etkili bir kurtarma prosedürüdür, özellikle de onarılamaz rotator manşet yırtığı olan hastalar için uygundur. Erken revizyon cerrahisi daha iyi fonksiyonel sonuçlarla ilişkilidir, gecikmiş revizyon ise artan ağrı ve azalmış omuz hareketliliğine yol açabilir.

Anahtar Kelimeler

Ters omuz artroplastisi , proksimal humerus kırıkları , başarısız iç fiksasyon , fonksiyonel sonuçlar , revizyon cerrahisi

Outcomes of Reverse Shoulder Arthroplasty in the Management of Proximal Humerus Fractures Following Failed Internal Fixation

Öz

Aim: This research aims to assess the clinical and functional outcomes of reverse shoulder arthroplasty (RSA) in patients with proximal humerus fractures who underwent revision surgery following unsuccessful internal fixation. The influence of fracture classification and the timing of revision surgery on postoperative pain, range of motion (ROM), and functional outcomes was also evaluated.
Material and Method: A retrospective analysis was performed on patients aged 65 years or older who sustained fractures due to low-energy trauma, such as simple falls, and underwent RSA due to failed internal fixation of proximal humerus fractures between 2017 and 2020. Patients with intraoperatively identified irreparable rotator cuff tears were included in the study.Functional outcomes were measured using the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, the Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH), and Visual Analog Scale (VAS). Additionally, ROM, including flexion, abduction, internal rotation, and external rotation, was assessed. Statistical comparisons were conducted based on fracture classification (Neer Type 3 vs. Neer Type 4) and the interval between the initial fixation and revision surgery.
Results: Patients with Neer Type 4 fractures had poorer functional outcomes and higher pain levels than those with Neer Type 3 fractures. The VAS score was higher (3.2±1.8 vs. 0.9±0.9), and the Constant-Murley score was lower (50.7±10.4 vs. 61.8±9.0) in Neer Type 4 patients. Delayed revision surgery led to greater functional decline, increased pain, and restricted motion. Flexion (102.9±23.1°) and abduction (99.4±19.2°) were better preserved in Neer Type 3 fractures than in Neer Type 4 (80.0±22.8° and 73.3±22.5°). However, RSA effectively reduced postoperative pain (VAS 1.5±1.5) and improved functional scores (ASES 59.0±21.3).
Conclusion: RSA serves as a reliable reconstructive option for managing complications arising from unsuccessful surgical stabilization of proximal humerus fractures, especially in cases where the rotator cuff damage is beyond repair. Early revision surgery is linked to superior functional recovery, whereas delayed intervention may result in heightened pain and restricted shoulder movement.

Anahtar Kelimeler

Reverse shoulder arthroplasty , proximal humerus fractures , failed ınternal fixation , functional outcomes , revision surgery

Kaynakça

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