Wallace A L, Phillips R L, MacDougal G A, Walsh W R, Sonnabend D H
Department of Orthopaedic Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom.
J Bone Joint Surg Am. 1999 Apr;81(4):510-8. doi: 10.2106/00004623-199904000-00008.
Clinically evident loosening of a glenoid component inserted with cement in total shoulder arthroplasty is infrequent, but radiographic changes that indicate loosening at the implant-bone interface are common and have been associated with functional limitation. We compared the results of total shoulder arthroplasties in which the glenoid implant had been inserted with cement with those of arthroplasties in which a bone-ingrowth glenoid implant had been inserted without cement.
The results of eighty-six consecutive total shoulder arthroplasties, performed by the same surgeon, were retrospectively reviewed between four and seven years after the operation. Fifty-eight shoulders in which the primary glenoid implant was in situ were assessed with use of the Simple Shoulder Test and Short Form-36 questionnaires, clinical examination, and fluoroscopic imaging of the glenoid implant-bone interface. Thirty-two of the glenoid components had been fixed with cement and twenty-six, without cement.
Complications occurred in 16 percent (fourteen) of the eighty-six shoulders, and 9 percent (eight) of the shoulders needed a revision operation. None of the revisions were done because of loosening of the glenoid component. Five of the eight revisions involved implants that had been inserted without cement. Three of these implants were revised because of early instability and two, because the polyethylene component had separated from the metal tray of the glenoid implant. With the numbers available, we could not detect any significant differences between the groups with respect to pain, range of motion, function of the shoulder, or general health. Radiographic analysis demonstrated a high level of interobserver agreement (kappa = 0.89). Radiolucent lines were observed after 41 percent (thirteen) of the thirty-two arthroplasties performed with cement compared with 23 percent (six) of the twenty-six arthroplasties performed without cement. The proportion of implants classified as probably loose was approximately three times greater in the group in which cement had been used. Eccentric wear of the posterior rim of the metal tray and focal osteolysis under the metal tray were observed in the group in which the component had been inserted without cement; these findings may indicate a potential for progression of radiographic loosening with increased durations of follow-up.
We concluded that, despite the higher rate of early complications, the intermediate-term outcomes of arthroplasties in which the glenoid implant is inserted without cement are comparable with those of arthroplasties with cementing of the glenoid component.
在全肩关节置换术中，采用骨水泥固定的关节盂假体出现临床明显松动的情况并不常见，但在假体-骨界面显示松动的影像学改变却很常见，且与功能受限有关。我们比较了采用骨水泥固定关节盂假体的全肩关节置换术与采用非骨水泥型骨长入关节盂假体的全肩关节置换术的结果。
回顾性分析由同一位外科医生连续进行的86例全肩关节置换术的结果，这些手术是在术后4至7年进行的。对58例初次关节盂假体在位的肩关节，使用简单肩关节测试和简短健康调查问卷36项、临床检查以及关节盂假体-骨界面的荧光透视成像进行评估。其中32例关节盂假体采用骨水泥固定，26例未采用骨水泥固定。
86例肩关节中有16%（14例）出现并发症，9%（8例）的肩关节需要翻修手术。没有一例翻修手术是因为关节盂假体松动。8例翻修手术中有5例涉及未采用骨水泥固定的假体。其中3例假体因早期不稳定而翻修，2例是因为聚乙烯部件与关节盂假体的金属托盘分离。就现有数据而言，我们未能发现两组在疼痛、活动范围、肩关节功能或总体健康方面存在任何显著差异。影像学分析显示观察者间的一致性较高（kappa = 0.89）。采用骨水泥进行的32例置换术中，41%（13例）出现了透亮线，而未采用骨水泥进行的26例置换术中这一比例为23%（6例）。在使用骨水泥的组中，被归类为可能松动的假体比例大约是未使用骨水泥组的三倍。在未采用骨水泥固定假体的组中，观察到金属托盘后缘的偏心磨损和金属托盘下方的局灶性骨质溶解；这些发现可能表明随着随访时间延长，影像学松动有进展的可能性。
我们得出结论，尽管早期并发症发生率较高，但未采用骨水泥固定关节盂假体的置换术的中期结果与采用骨水泥固定关节盂假体的置换术相当。
