Wirth Michael A, Lim Moon-Sup, Southworth Carleton, Loredo Rebecca, Kaar T Kenneth, Rockwood Charles A
University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7774, USA.
J Bone Joint Surg Am. 2007 Jan;89(1):49-57. doi: 10.2106/JBJS.E.01069.
Compaction bone-grafting has been suggested as a means of improving the stability of the humeral component in shoulder arthroplasty, but the clinical and radiographic results of the procedure have not been reported in the literature, to our knowledge. To address this deficit, we report on a series of shoulder arthroplasties performed with compaction bone-grafting to secure humeral component fixation. These prostheses were implanted in shoulders demonstrating a suboptimal interference fit of the humeral component.
Fifty-eight shoulders in fifty-three patients were treated with prosthetic shoulder arthroplasty that included compaction bone-grafting. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort and function, and overall quality of life, and with use of patient self-assessments including the American Shoulder and Elbow Surgeons Score and the validated Simple Shoulder Test. A detailed radiographic analysis was performed by three raters to determine whether radiolucent lines were present immediately postoperatively and at a later follow-up interval. The humeral tilt angle was determined by measuring the angle between the humeral axis and the component. Subsidence was also evaluated. The mean of the raters' measurements was used in the analysis.
The mean duration of follow-up was sixty-nine months (range, twenty-six to 148 months). No loose stems were observed, and no humeral component was revised. At the time of follow-up, there was significant improvement in the Simple Shoulder Test scores and all visual analog scores (p < 0.0001 in each instance). Thirty-four stems had no radiolucent line at the time of follow-up, and the mean maximum thickness of the lucent lines was 0.21 mm in the entire group of fifty-eight shoulders. Most lucent lines occurred near the distal stem tip. The mean tilt of the valgus and varus humeral components was 2.2 degrees and 2.6 degrees , respectively, on the immediate postoperative radiographs. No humeral component shifted from varus to valgus or vice versa. The duration of follow-up was not correlated with the maximum thickness of the humeral component lucency, and the presence or absence of a prosthetic glenoid was also unrelated to the maximum thickness of the lucency.
Compaction bone-grafting in shoulder arthroplasty can yield stable and durable fixation of the humeral component, as seen clinically and radiographically, without use of cement. Our findings provide evidence that compaction bone-grafting in shoulder arthroplasty is an option to ensure intermediate-term fixation (at a mean of five years) of humeral components that have a suboptimal fit.
骨打压植骨已被提议作为一种提高肩关节置换术中肱骨假体稳定性的方法，但据我们所知，该手术的临床和影像学结果在文献中尚未见报道。为填补这一空白，我们报告了一系列采用骨打压植骨以确保肱骨假体固定的肩关节置换术。这些假体被植入肱骨假体压配欠佳的肩关节中。
对53例患者的58个肩关节进行了包括骨打压植骨的人工肩关节置换术治疗。定期使用视觉模拟量表评估疼痛、肩部舒适度和功能以及总体生活质量，并采用患者自我评估，包括美国肩肘外科医师评分和经过验证的简单肩部测试。由三名评估者进行详细的影像学分析，以确定术后即刻及后期随访时是否存在透亮线。通过测量肱骨轴线与假体之间的角度来确定肱骨倾斜角。还评估了下沉情况。分析中使用评估者测量值的平均值。
平均随访时间为69个月（范围为26至148个月）。未观察到松动的假体柄，也未对任何肱骨假体进行翻修。随访时，简单肩部测试评分和所有视觉模拟评分均有显著改善（每种情况p < 0.0001）。34个假体柄在随访时无透亮线，在整个58个肩关节组中，透亮线的平均最大厚度为0.21 mm。大多数透亮线出现在假体柄远端附近。术后即刻X线片上，外翻和内翻肱骨假体的平均倾斜度分别为2.2度和2.6度。没有肱骨假体从内翻变为外翻或反之。随访时间与肱骨假体透亮的最大厚度无关，有无假体肩胛盂也与透亮的最大厚度无关。
肩关节置换术中的骨打压植骨在临床和影像学上均可实现肱骨假体稳定且持久的固定，无需使用骨水泥。我们的研究结果提供了证据，表明肩关节置换术中的骨打压植骨是确保压配欠佳的肱骨假体中期（平均五年）固定的一种选择。
