Habermeyer Peter, Magosch Petra, Lichtenberg Sven
Department of Shoulder and Elbow Surgery, ATOS Clinic, Heidelberg, Germany.
Clin Orthop Relat Res. 2007 Apr;457:124-32. doi: 10.1097/BLO.0b013e31802ff03c.
Substantial posterior glenoid wear causing static posterior subluxation of the humeral head in patients with primary osteoarthritis has been described. Persistent humeral head subluxation after total shoulder arthroplasty can result in early polyethylene wear and glenoid component loosening. In our prospective cohort study, we hypothesized that in patients with posterior glenoid wear from osteoarthritis, static posterior decentering of the humeral head could be recentered during total shoulder arthroplasty by surgical correction of glenoid alignment in the transverse plane with soft tissue balancing. We performed total shoulder arthroplasties in 77 patients with primary osteoarthritis and a mean age of 67.6 years. The mean clinical and radiographic followup was 2 years (range, 1-7 years). Patients with preoperative posteriorly decentered humeral heads did not have posterior decentering develop postoperatively. Twenty patients (83.3%) had centered humeral heads and four patients (16.6%) had anterior decentering. Midterm results of total shoulder arthroplasties in shoulders with humeral head decentering caused by glenoid deficiency in the transverse plane showed correction of the decentering by lowering the high side or by bone grafting with soft tissue balancing can be well maintained.
已有文献报道，在原发性骨关节炎患者中，肩胛盂后方大量磨损会导致肱骨头静态后脱位。全肩关节置换术后持续的肱骨头半脱位可导致早期聚乙烯磨损和肩胛盂假体松动。在我们的前瞻性队列研究中，我们假设，在因骨关节炎导致肩胛盂后方磨损的患者中，通过在软组织平衡的情况下在矢状面手术矫正肩胛盂对线，全肩关节置换术中肱骨头的静态后脱位可以得到复位。我们对77例原发性骨关节炎患者进行了全肩关节置换术，患者平均年龄67.6岁。临床和影像学随访的平均时间为2年（范围1 - 7年）。术前肱骨头后脱位的患者术后未出现后脱位。20例患者（83.3%）肱骨头复位，4例患者（16.6%）肱骨头前脱位。对于因矢状面肩胛盂缺损导致肱骨头脱位的肩关节，全肩关节置换术的中期结果显示，通过降低高位侧或进行骨移植并结合软组织平衡来矫正脱位，可以得到良好维持。
