Gartsman G M, Roddey T S, Hammerman S M
Texas Orthopedic Hospital, Houston 77030, USA.
J Bone Joint Surg Am. 2000 Jan;82(1):26-34. doi: 10.2106/00004623-200001000-00004.
The indications for resurfacing of the glenoid in patients who have osteoarthritis of the shoulder are not clearly defined; some investigators routinely perform hemiarthroplasty whereas others perform total shoulder arthroplasty.
Forty-seven patients (fifty-one shoulders) who were scheduled to have a shoulder arthroplasty for the treatment of degenerative osteoarthritis were randomly assigned, according to a random-numbers table, to one of two groups: replacement of the humeral head with resurfacing of the glenoid with a polyethylene component with cement (total shoulder arthroplasty [twenty-seven shoulders]) or replacement of the humeral head without resurfacing of the glenoid (hemiarthroplasty [twenty-four shoulders]). All patients received the same type of humeral component, and all operations were performed by or under the direct supervision of the same surgeon. The patients were followed for a mean of thirty-five months (range, twenty-four to seventy-two months) postoperatively. Evaluation was performed with use of the scoring systems of the University of California at Los Angeles and the American Shoulder and Elbow Surgeons.
No difference was observed between the preoperative scores for the two groups of patients. Postoperatively, the mean scores with use of the University of California at Los Angeles system and the American Shoulder and Elbow Surgeons system were 23.2 points (range, 10 to 31 points) and 65.2 points (range, 15 to 94 points), respectively, after hemiarthroplasty and 27.4 points (range, 9 to 34 points) and 77.3 points (range, 3 to 100 points), respectively, after total shoulder arthroplasty. With the numbers available for study, no significant difference was found between the two operative groups with respect to the postoperative score. (Thirty-five subjects per group would be needed, assuming an effect size of 0.60 and a power of 0.80.) Total shoulder arthroplasty provided significantly greater pain relief (p = 0.002) and internal rotation (p = 0.003) than hemiarthroplasty did. Total shoulder arthroplasty also provided superior results in the specific areas of patient satisfaction, function, and strength, although none of these differences were found to be significant, with the numbers available. Total shoulder arthroplasty was associated with increased cost ($1177), operative time (thirty-five minutes), and blood loss (150 milliliters) per patient compared with hemiarthroplasty. To date, none of the total shoulder arthroplasties in the study group have been revised. Hemiarthroplasty yielded equivalent results for elevation and external rotation. Three of the twenty-five patients who had had a hemiarthroplasty needed a subsequent operation for resurfacing of the glenoid. The mean cost for the revision operations was $15,998.
Total shoulder arthroplasty provided superior pain relief compared with hemiarthroplasty in patients who had glenohumeral osteoarthritis, but it was associated with an increased cost of $1177 per patient.
对于患有肩关节骨关节炎的患者，关节盂表面置换的适应证尚未明确界定；一些研究者常规施行半关节成形术，而另一些则施行全肩关节置换术。
47例（51个肩关节）因退行性骨关节炎计划行肩关节置换术的患者，根据随机数字表随机分为两组：用带骨水泥的聚乙烯部件行关节盂表面置换并置换肱骨头（全肩关节置换术[27个肩关节]）或仅置换肱骨头而不行关节盂表面置换（半关节成形术[24个肩关节]）。所有患者均接受相同类型的肱骨头部件，所有手术均由同一位外科医生或在其直接监督下进行。术后对患者平均随访35个月（范围为24至72个月）。采用加利福尼亚大学洛杉矶分校和美国肩肘外科医生协会的评分系统进行评估。
两组患者术前评分无差异。术后，半关节成形术后采用加利福尼亚大学洛杉矶分校系统和美国肩肘外科医生协会系统的平均评分分别为23.2分（范围为10至31分）和65.2分（范围为15至94分），全肩关节置换术后分别为27.4分（范围为9至34分）和77.3分（范围为3至100分）。就现有研究数量而言，两个手术组术后评分无显著差异。（假设效应大小为0.60，检验效能为0.80，则每组需要35名受试者。）与半关节成形术相比，全肩关节置换术在缓解疼痛方面（p = 0.002）和内旋方面（p = 0.003）有显著改善。全肩关节置换术在患者满意度、功能及力量等特定方面也有更好的结果，尽管就现有数量而言，这些差异均无统计学意义。与半关节成形术相比，全肩关节置换术使每位患者的费用增加（1177美元）、手术时间延长（35分钟）及失血量增加（150毫升）。迄今为止，研究组中所有全肩关节置换术均未进行翻修。半关节成形术在抬高和外旋方面产生了相当的结果。25例行半关节成形术的患者中有3例需要后续行关节盂表面置换手术。翻修手术的平均费用为15,998美元。
在患有盂肱关节骨关节炎的患者中，与半关节成形术相比，全肩关节置换术在缓解疼痛方面更优，但每位患者的费用增加1177美元。
