Boyer P, Huten D, Alnot J-Y
Service d'Orthopédie et de Traumatologie, Hôpital Bichat, Université Paris VIII, 46 rue Henri-Huchard, 75877 Paris Cedex.
Rev Chir Orthop Reparatrice Appar Mot. 2006 Oct;92(6):556-66. doi: 10.1016/s0035-1040(06)75913-x.
The goal of this study was to assess the clinical and radiological outcome of bipolar shoulder prosthesis in twelve shoulders with rheumatoid arthritis (RA) and irreparable rotator cuff tears.
The follow-up was more than five years (range 2-9 years). In addition, in order to investigate the effect of rheumatoid arthritis on outcome, results were compared with ten bipolar shoulder prostheses implanted for osteoarthritis with massive rotator cuff tears.
The mean preoperative Constant score was 16.9 points with 2.6 points for pain, 4.2 points for activity, 9.5 points for motion and 0.6 points for force. The preoperative active motion was 63.8 degrees for forward flexion, 45 degrees for abduction and 12 degrees for active external rotation. At last follow-up, the average Constant score was 39.4 points with 10.7 points for pain, 10.8 points for activity, 13.8 points for motion and 4.1 points for force. Regarding the active motion, mean forward flexion was 83.7 degrees, 70.4 degrees for abduction and 29.1 degrees for external rotation. The complication rate was low, mainly superior migration due to infraspinatus tear and glenoid wear. Satisfactory deltoid arm level was achieved in all patients and no loosening was observed. Preoperative and postoperative scores of the rheumatoid group were not significantly different from the arthritis group (p<0.001).
Our findings suggest that bipolar shoulder prosthesis provides a viable replacement alternative in RA combined with massive rotator cuff tear with a low rate of complication. Bipolar shoulder prosthesis demonstrates no clear superiority over conventional hemiarthroplasty regarding improved motion and glenoid wear. In addition, no significant difference with arthritis was observed (p<0.05), assuming that outcome depends principally on the preoperative condition of the rotator cuff.
Some massive tears involving the subscapularis tendon can lead to anterior recurrence after bipolar shoulder prosthesis. They might be a limit to the procedure and require a reversed shoulder prosthesis or a glenohumeral arthrodesis.
本研究的目的是评估双极型肩关节假体在12例患有类风湿性关节炎（RA）且肩袖撕裂无法修复的肩部的临床和影像学结果。
随访时间超过5年（范围为2 - 9年）。此外，为了研究类风湿性关节炎对结果的影响，将结果与10例因骨关节炎伴巨大肩袖撕裂而植入双极型肩关节假体的病例进行了比较。
术前平均Constant评分16.9分，其中疼痛2.6分，活动度4.2分，活动范围9.5分，力量0.6分。术前主动活动度为前屈63.8度，外展45度，主动外旋12度。末次随访时，平均Constant评分为39.4分，其中疼痛10.7分，活动度10.8分，活动范围13.8分，力量4.1分。关于主动活动度，平均前屈为83.7度，外展70.4度，外旋29.1度。并发症发生率较低，主要是由于冈下肌撕裂和关节盂磨损导致的假体上移。所有患者均达到了满意的三角肌功能水平，未观察到假体松动。类风湿组术前和术后评分与骨关节炎组无显著差异（p<0.001）。
我们的研究结果表明，双极型肩关节假体为RA合并巨大肩袖撕裂提供了一种可行的替代置换方案，并发症发生率较低。在改善活动度和关节盂磨损方面，双极型肩关节假体相较于传统半肩关节置换术并无明显优势。此外，与骨关节炎组未观察到显著差异（p<0.05），推测结果主要取决于肩袖的术前状况。
一些累及肩胛下肌腱的巨大撕裂在双极型肩关节假体植入后可能导致前方复发。它们可能是该手术的一个限制因素，需要采用反置式肩关节假体或盂肱关节融合术。
