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Inverse Schulterprothese bei proximalen Humerusfrakturen

Gesundheitsbezogene Lebensqualität

Reversed total shoulder arthroplasty for proximal humerus fractures

Health-related quality of life

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Zusammenfassung

Hintergrund

Studien zur Implantation einer inversen Schulterprothese wegen einer proximalen Humerusfraktur verwenden häufig Funktion und Schmerz als Zielgrößen. Aber auch andere Dimensionen der gesundheitsbezogenen Lebensqualität („health-related quality of life“, HRQOL) können theoretisch betroffen sein. Bisher existieren nur wenige Arbeiten, die sich mit den Auswirkungen auf den Gesundheitszustand, die über die funktionellen Einschränkungen hinausgehen, befassen.

Fragestellung

Daher ergab sich die Frage, ob bei diesen Patienten Beeinträchtigungen der HRQOL nachweisbar sind.

Material und Methoden

Wegen einer proximalen Humerusfraktur wurden 21 Patienten mit inverser Schulterprothese prospektiv über 12 Monate beobachtet. Die funktionellen Ergebnisse wurden mit dem Constant- und DASH-(„Disability of shoulder, arms and hand questionnaire“-)Score gemessen, die HRQOL mit dem SF-36-Fragebogen („short form 36“). Den Patienten wurde ein bezüglich Alter, Geschlecht und Wohnort gleicher Teilnehmer aus der Studie zur Gesundheit Erwachsener des Robert-Koch-Instituts zugeordnet. Die 8 Skalen beider Gruppen wurden miteinander verglichen (t-Test).

Ergebnisse

Der mittlere Constant-Score betrug 50 Punkte (Range 12–77, Standardabweichung [SD] 17), alters- und geschlechtsadaptiert 61 % (Range 15–95, SD 21). Der DASH lag im Mittel bei 52 (Range 15–98, SD 25). In 3 der 8 Subskalen (körperliche Funktionsfähigkeit, Vitalität, allgemeine Gesundheitswahrnehmung) zeigte die Patientenkohorte einen signifikanten Unterschied zur deutschen Normalbevölkerung.

Schlussfolgerung

Eine inverse Schulterprothese nach proximaler Humerusfraktur beeinflusst die funktionellen und darüber hinausgehenden Aspekte der HRQL. Instrumente zur Messung der HRQOL sind sinnvolle Ergänzungen zu gebräuchlichen Scores bei diesen Patienten.

Abstract

Background

Results reported in articles on reversed total shoulder arthroplasty (RTSA) for proximal humerus fractures are usually presented as a score that measures functional status and pain. However, other dimensions of the health-related quality of life (HRQOL) can also be theoretically affected. Studies regarding HRQOL as an outcome in these patients are rare.

Objectives

The aim of the study was to detect impairments of HRQOL by RTSA.

Materials and methods

In all, 21 patients with RTSA for proximal humerus fracture were prospectively followed for 12 months. Functional results were assessed according to the Constant–Murley and Disabilities of the Arm, Shoulder and Hand scores. HRQOL was measured using the SF-36 questionnaire. Patients were matched with participants of the German Health Interview and Examination Survey of the Robert Koch Institute according to age, sex, and place of residence. HRQOL of both groups were compared using Student’s t‑test.

Results

The mean raw Constant–Murley score was 50 points (range 12–77 points, standard deviation [SD] 17 points), the age- and gender-adjusted score was 61% (range 15–95%, SD 21%), and the mean DASH score was 52 points (range 15–98 points, SD 25 points). Three of eight subscales (physical functioning, vitality, general health perceptions) of the SF-36 showed significant differences compared to the general population in Germany.

Conclusions

Undergoing RTSA for proximal humerus fractures influences functional and other dimensions of health status. Instruments measuring HRQOL should be added to traditional sets of outcomes in clinical studies on this topic.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland

    Thomas Willert, Tony Schmidt, Josephine Gehring, Jörg Weber & Thomas Westphal

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  1. Thomas Willert
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  2. Tony Schmidt
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Correspondence to Thomas Willert.

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Interessenkonflikt

T. Willert, T. Schmidt, J. Gehring, J. Weber und T. Westphal geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Willert, T., Schmidt, T., Gehring, J. et al. Inverse Schulterprothese bei proximalen Humerusfrakturen. Obere Extremität 12, 177–182 (2017). https://doi.org/10.1007/s11678-017-0410-8

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  • DOI: https://doi.org/10.1007/s11678-017-0410-8

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