Iannotti Joseph P, Norris Tom R
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
J Bone Joint Surg Am. 2003 Feb;85(2):251-8. doi: 10.2106/00004623-200302000-00011.
The results of shoulder arthroplasty for osteoarthritis have been reported to be excellent or good for the majority of patients, but the value of using a glenoid component and the anatomic factors that affect outcome are still debated. The purpose of this study was to evaluate the influence of an operatively confirmed full-thickness tear of the rotator cuff, the severity of preoperative erosion of glenoid bone, preoperative radiographic evidence of subluxation of the humeral head, and the severity of preoperative loss of the passive range of motion on the outcome of total shoulder arthroplasty and hemiarthroplasty.
In a multicenter clinical outcome study, we evaluated 128 shoulders in 118 patients with primary osteoarthritis who had been followed for a mean of forty-six months (range, twenty-four to eighty-seven months).
Patients with <10 degrees of passive external rotation preoperatively had significantly less improvement in external rotation after hemiarthroplasty (p = 0.006). Thirteen (10%) of the 128 shoulders had a repairable full-thickness tear of the supraspinatus tendon, but these tears did not affect the overall American Shoulder and Elbow Surgeons score, the decrease in pain, or patient satisfaction. Severe or moderate eccentric glenoid erosion was seen in twenty-nine (23%) of the 128 shoulders, and total shoulder arthroplasty resulted in significantly better passive total elevation and active external rotation as well as a trend toward significantly better active forward flexion than did hemiarthroplasty in these shoulders. The humeral head was subluxated posteriorly in twenty-three shoulders (18%), and when they were compared with the other shoulders in the study, these shoulders were found to have lower final American Shoulder and Elbow Surgeons scores, more pain, and decreased active external rotation following either total shoulder arthroplasty or hemiarthroplasty.
On the basis of our data, we recommend the use of a glenoid component in shoulders with glenoid erosion. Humeral head subluxation was associated with a less favorable result regardless of the type of shoulder arthroplasty and must be considered in preoperative planning and counseling. Severe loss of the passive range of motion preoperatively was associated with a decreased passive range of motion postoperatively. A repairable tear of the supraspinatus tendon is not a contraindication to the use of a glenoid component. .
据报道，大多数骨关节炎患者接受肩关节置换术后效果优良，但使用关节盂假体的价值以及影响疗效的解剖学因素仍存在争议。本研究的目的是评估经手术证实的肩袖全层撕裂、关节盂骨术前侵蚀的严重程度、术前肱骨头半脱位的影像学证据以及术前被动活动范围丧失的严重程度对全肩关节置换术和半肩关节置换术疗效的影响。
在一项多中心临床疗效研究中，我们评估了118例原发性骨关节炎患者的128个肩关节，平均随访46个月（范围为24至87个月）。
术前被动外旋<10度的患者，半肩关节置换术后外旋改善明显较少（p = 0.006）。128个肩关节中有13个（10%）存在可修复的冈上肌腱全层撕裂，但这些撕裂并未影响美国肩肘外科医师协会的总体评分、疼痛减轻程度或患者满意度。128个肩关节中有29个（23%）出现严重或中度偏心性关节盂侵蚀，在这些肩关节中，全肩关节置换术导致的被动总抬高和主动外旋明显优于半肩关节置换术，主动前屈也有明显更好的趋势。23个肩关节（18%）的肱骨头向后半脱位，与研究中的其他肩关节相比，这些肩关节在全肩关节置换术或半肩关节置换术后的最终美国肩肘外科医师协会评分更低、疼痛更严重、主动外旋减少。
根据我们的数据，我们建议在存在关节盂侵蚀的肩关节中使用关节盂假体。无论肩关节置换的类型如何，肱骨头半脱位都与较差的结果相关，在术前规划和咨询中必须予以考虑。术前被动活动范围严重丧失与术后被动活动范围减少相关。冈上肌腱可修复的撕裂并非使用关节盂假体的禁忌证。
