Lynch Joseph R, Franta Amy K, Montgomery William H, Lenters Tim R, Mounce Doug, Matsen Frederick A
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356500, Seattle, WA 98195, USA.
J Bone Joint Surg Am. 2007 Jun;89(6):1284-92. doi: 10.2106/JBJS.E.00942.
Active and young individuals with glenohumeral arthritis who are treated with total glenohumeral arthroplasty are at risk for loosening or wear of the prosthetic glenoid component. This study tests the hypothesis that patients with severe glenohumeral arthritis have improvement in self-assessed shoulder comfort and function at two to four years after treatment with the combination of humeral hemiarthroplasty and concentric glenoid reaming without tissue or prosthetic component interposition.
Thirty-seven consecutive patients (thirty-eight shoulders), with a mean age of fifty-seven years, who were managed by one surgeon were enrolled in this prospective study. The procedure consisted of an uncemented humeral hemiarthroplasty combined with reaming of the glenoid to a diameter 2 mm larger than that of the prosthetic humeral head. The duration of follow-up ranged from two to four years (average, 2.7 years) for thirty-five shoulders. Self-assessed comfort and function was documented with use of the Simple Shoulder Test, and radiographs were evaluated.
Thirty-two shoulders demonstrated improved comfort and function according to patient self-assessment, one demonstrated no change, and two had worse function following the procedure. The total number of Simple Shoulder Test functions that could be performed increased from 4.7 (of a possible 12.0) before surgery to 9.4 at the time of the final follow-up. The patients demonstrated significant improvement in ten of the twelve individual functions of the Simple Shoulder Test (p < 0.022 to p < 0.00001). With the numbers studied, gender, diagnosis, age, glenoid wear, and preoperative glenoid erosion did not significantly affect final shoulder function or overall improvement. The range of motion was significantly improved for all individuals (p < 0.00001). Radiographically, twenty-two patients had a joint space between the glenoid bone and the humeral prosthesis at the time of final follow-up. These shoulders had significantly better function than those without a preserved joint space (p < 0.017). There were no surgical complications and no revisions to total shoulder arthroplasty.
At a minimum follow-up of two years, a selected series of patients who had humeral hemiarthroplasty with concentric glenoid reaming for the treatment of glenohumeral arthritis showed significant improvement in self-assessed shoulder comfort and function. Further study, however, is needed before routine application of this procedure can be recommended.
Therapeutic Level IV.
接受全肩关节置换术治疗的患有盂肱关节炎的活跃年轻个体，其假体盂部件存在松动或磨损的风险。本研究检验了这样一个假设：对于患有严重盂肱关节炎的患者，在接受肱骨半关节置换术和同心盂扩孔术联合治疗且不进行组织或假体部件置入后，两到四年时其自我评估的肩部舒适度和功能会有所改善。
本前瞻性研究纳入了由一名外科医生治疗的37例连续患者（38个肩关节），平均年龄57岁。该手术包括非骨水泥型肱骨半关节置换术，同时将盂扩孔至比假体肱骨头直径大2毫米。35个肩关节的随访时间为2至4年（平均2.7年）。使用简易肩关节测试记录自我评估的舒适度和功能，并对X线片进行评估。
根据患者自我评估，32个肩关节的舒适度和功能有所改善，1个无变化，2个术后功能变差。简易肩关节测试可执行功能的总数从术前的4.7项（可能的12项中的）增加到最终随访时的9.4项。患者在简易肩关节测试的12项个体功能中的10项上有显著改善（p < 0.022至p < 0.00001）。就所研究的数量而言，性别、诊断、年龄、盂磨损和术前盂侵蚀并未显著影响最终肩部功能或总体改善情况。所有个体的活动范围均有显著改善（p < 0.00001）。在X线片上，22例患者在最终随访时，盂骨与肱假体之间存在关节间隙。这些肩关节的功能明显优于没有保留关节间隙的肩关节（p < 0.017）。没有手术并发症，也没有进行全肩关节置换术的翻修。
在至少两年的随访中，一组接受肱骨半关节置换术和同心盂扩孔术治疗盂肱关节炎的特定患者，其自我评估的肩部舒适度和功能有显著改善。然而，在推荐常规应用该手术之前，还需要进一步研究。
治疗性四级。
