Cheung Emilie V, Sperling John W, Cofield Robert H
Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2007 Aug;89(8):1777-83. doi: 10.2106/JBJS.F.00711.
Glenoid component loosening has been a leading cause of failure of total shoulder arthroplasty. In the present study, we evaluated the outcome of reimplantation of a new glenoid component following removal of the previous glenoid component and placement of an allograft in order to determine the results, risk factors for an unsatisfactory outcome, and rate of failure associated with this procedure.
We reviewed the data on seven shoulders in seven patients. At the time of glenoid component reimplantation, two shoulders received a cemented all-polyethylene glenoid component, three received a bone-ingrowth metal-backed component with columns and screws, and two received a bone-ingrowth metal-backed component with columns and screws augmented with bone cement. The average duration of follow-up was seventy-nine months. At the time of the latest follow-up, all patients were evaluated clinically and radiographically, patient satisfaction was assessed, and the result was graded according to a modified Neer rating system.
Two patients had positive growth of Propionibacterium acnes on culture of intraoperative specimens obtained at the time of revision surgery and had continuing pain, and both underwent repeat revision. The remaining five patients expressed satisfaction with the procedure and stated that they felt better following surgery. The mean preoperative pain score for these five patients (on a scale from 1 to 5) was 4.6, and the mean postoperative pain score was 2.4 (p = 0.0042). Range of motion, however, did not improve. The Neer rating of the result (determined for the five patients who did not undergo repeat revision) was excellent for one patient, satisfactory for one, and unsatisfactory (because of limitation of motion) for three.
Reimplantation of a glenoid component into a previously grafted bed can provide pain relief for most patients, but motion cannot be reliably improved.
肩胛盂假体松动一直是全肩关节置换术失败的主要原因。在本研究中，我们评估了在移除先前的肩胛盂假体并植入同种异体骨后重新植入新的肩胛盂假体的结果，以确定该手术的疗效、预后不佳的危险因素以及与之相关的失败率。
我们回顾了7例患者7个肩关节的数据。在重新植入肩胛盂假体时，2个肩关节植入了骨水泥固定的全聚乙烯肩胛盂假体，3个植入了带柱和螺钉的骨长入金属背衬假体，2个植入了带柱和螺钉并辅以骨水泥增强的骨长入金属背衬假体。平均随访时间为79个月。在最近一次随访时，对所有患者进行了临床和影像学评估，评估了患者满意度，并根据改良的Neer评分系统对结果进行分级。
2例患者在翻修手术时获取的术中标本培养中发现痤疮丙酸杆菌生长阳性且持续疼痛，均接受了再次翻修。其余5例患者对手术表示满意，并表示术后感觉好转。这5例患者术前平均疼痛评分为4.6分（1至5分制），术后平均疼痛评分为2.4分（p = 0.0042）。然而，活动范围并未改善。（对未进行再次翻修的5例患者）结果的Neer评分中，1例为优，1例为良，3例为差（因活动受限）。
将肩胛盂假体重新植入先前的移植床可为大多数患者缓解疼痛，但活动范围无法可靠改善。
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