Sperling John W, Antuna Samuel A, Sanchez-Sotelo Joaquin, Schleck Cathy, Cofield Robert H
Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
J Bone Joint Surg Am. 2002 Oct;84(10):1775-81. doi: 10.2106/00004623-200210000-00006.
We are not aware of any large published studies regarding the intermediate to long-term results of shoulder arthroplasty performed for the treatment of osteoarthritis after instability surgery. Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients.
Between January 1, 1978, and December 31, 1997, thirty-three patients (thirty-three shoulders) with glenohumeral arthritis after instability surgery were treated with a shoulder arthroplasty at our institution. Two patients were excluded from the study: one died less than two years postoperatively, and one had not been managed by the senior surgeon. The remaining thirty-one patients, including twenty-one patients who had had a total shoulder arthroplasty and ten who had had a hemiarthroplasty, were followed for a minimum of two years (mean, seven years) or until the time of revision surgery. The mean age at the time of the shoulder arthroplasty was forty-six years.
Shoulder arthroplasty was associated with significant pain relief (p < 0.001) as well as significant improvement in external rotation (from 4 degrees to 43 degrees; p < 0.001) and active abduction (from 94 degrees to 141 degrees; p < 0.001). There was not a significant difference between the hemiarthroplasty group and the total shoulder arthroplasty group with regard to postoperative external rotation, active abduction, or pain. According to a modification of the rating system of Neer et al., there were four excellent, two satisfactory, and four unsatisfactory results in the hemiarthroplasty group and three excellent, five satisfactory, and thirteen unsatisfactory results in the total shoulder arthroplasty group. Three patients in the hemiarthroplasty group and eight patients in the total shoulder arthroplasty group underwent revision surgery. The estimated survival of the components (and 95% confidence interval) was 97% (91% to 100%) at two years, 86% (74% to 99%) at five years, and 61% (42% to 86%) at ten years.
The data from the present study suggest that shoulder arthroplasty for the treatment of osteoarthritis of the glenohumeral joint following instability surgery in this relatively young group of patients provides pain relief and improved motion but is associated with high rates of revision surgery and unsatisfactory results due to component failure, instability, and pain due to glenoid arthritis.
我们尚未知晓任何已发表的关于不稳定手术后行肩关节置换术治疗骨关节炎的中长期结果的大型研究。因此，我们回顾了该手术的结果、预后不佳的风险因素以及我们患者中的失败率。
在1978年1月1日至1997年12月31日期间，我们机构对33例（33个肩关节）不稳定手术后出现盂肱关节炎的患者进行了肩关节置换术治疗。两名患者被排除在研究之外：一名术后不到两年死亡，一名未由资深外科医生治疗。其余31例患者，包括21例行全肩关节置换术和10例行半肩关节置换术的患者，随访至少两年（平均7年）或直至翻修手术时。肩关节置换术时的平均年龄为46岁。
肩关节置换术与疼痛显著缓解（p < 0.001）以及外旋（从4度至43度；p < 0.001）和主动外展（从94度至141度；p < 0.001）显著改善相关。半肩关节置换术组和全肩关节置换术组在术后外旋、主动外展或疼痛方面无显著差异。根据Neer等人评分系统的改良版，半肩关节置换术组有4例优、2例良和4例差的结果，全肩关节置换术组有3例优、5例良和13例差的结果。半肩关节置换术组有3例患者和全肩关节置换术组有8例患者接受了翻修手术。假体的估计生存率（及95%置信区间）在两年时为97%（91%至100%），五年时为86%（74%至99%），十年时为61%（42%至86%）。
本研究的数据表明，在这群相对年轻的患者中，不稳定手术后行肩关节置换术治疗盂肱关节骨关节炎可缓解疼痛并改善活动度，但与因假体失败、不稳定以及盂肱关节炎疼痛导致的高翻修手术率和不佳结果相关。
