Bailie David S, Llinas Paulo J, Ellenbecker Todd S
The Orthopedic Clinic Association, 9377 East Bell Road, Suite 231, Scottsdale, AZ 85260, USA.
J Bone Joint Surg Am. 2008 Jan;90(1):110-7. doi: 10.2106/JBJS.F.01552.
Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients who were less than fifty-five years of age.
We reviewed prospectively collected clinical data on a series of thirty-six patients under fifty-five years of age with end-stage glenohumeral arthrosis, but without osteonecrosis, who had undergone a cementless humeral resurfacing hemiarthroplasty performed by a single surgeon. All patients were followed for a minimum of two years. We assessed pain, function, and patient satisfaction and documented all complications. Radiographs were evaluated for implant loosening.
The thirty-six patients had a mean age of 42.3 years and were followed for a mean of 38.1 months. Scores measured with a visual analog pain scale, the Single Assessment Numeric Evaluation (SANE) scale, and the American Shoulder and Elbow Surgeons (ASES) scale all improved significantly from preoperatively to two years postoperatively (p < 0.001). Complications included one traumatic subscapularis rupture at six weeks, three cases of arthrofibrosis, and one deep hematoma. No obvious radiographic evidence of loosening was noted at the time of the latest follow-up. One shoulder was converted to a stemmed total shoulder arthroplasty at twenty-four months because of pain, but the implant was not loose at the revision. The remaining thirty-five patients were satisfied with the outcome at the time of the latest follow-up and had returned to their desired activity.
Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. Long-term follow-up is needed to determine if these results persist.
非骨水泥型肱骨表面置换术是一种用于治疗肩肱关节炎患者的保留骨质的关节置换术选择。该手术在老年患者群体中已取得成功。然而，关于年轻、活动量较大患者的关节置换术结果的数据却很缺乏。我们报告了该手术在年龄小于55岁的活动患者中的两年结果。
我们前瞻性地回顾了一系列36例年龄小于55岁、患有终末期肩肱关节病但无骨坏死的患者的临床数据，这些患者均由同一位外科医生实施了非骨水泥型肱骨表面半关节置换术。所有患者均接受了至少两年的随访。我们评估了疼痛、功能和患者满意度，并记录了所有并发症。对X线片进行评估以检查植入物松动情况。
这36例患者的平均年龄为42.3岁，平均随访时间为38.1个月。采用视觉模拟疼痛量表、单一评估数字评价（SANE）量表和美国肩肘外科医生（ASES）量表测量的评分，从术前到术后两年均有显著改善（p < 0.001）。并发症包括6周时1例创伤性肩胛下肌破裂、3例关节纤维性强直和1例深部血肿。在最近一次随访时，未发现明显的植入物松动的影像学证据。1例肩部在24个月时因疼痛转换为带柄全肩关节置换术，但翻修时植入物未松动。其余35例患者在最近一次随访时对结果满意，并已恢复到他们期望的活动水平。
非骨水泥型肱骨表面置换术是年轻、活动患者的一种可行治疗选择。早期结果表明，可以预期获得期望的功能和疼痛缓解。尽管许多患者活动水平较高，但短期内植入物松动和肩胛盂磨损似乎不是问题。需要进行长期随访以确定这些结果是否持续存在。
