Goldberg Steven S, Bell John-Erik, Kim Han Jo, Bak Sean F, Levine William N, Bigliani Louis U
Department of Orthopaedic Surgery, Physicians Regional Medical Center, 6101 Pine Ridge Road, Naples, FL 34119, USA.
J Bone Joint Surg Am. 2008 Mar;90(3):554-9. doi: 10.2106/JBJS.F.01029.
Hemiarthroplasty is a common treatment for cuff tear arthropathy and glenohumeral arthritis associated with a massive tear of the rotator cuff; however, to our knowledge, long-term outcomes and preoperative factors affecting results have not been reported.
Thirty-four shoulders in thirty-one patients with cuff tear arthropathy or a massive rotator cuff tear with glenohumeral arthritis underwent hemiarthroplasty at an average age of seventy-two years. Outcomes in all patients were evaluated by direct physical examination and according to the limited goals criteria of Neer et al. at a mean of 3.7 years postoperatively. In twenty-five shoulders, long-term outcomes were measured with use of the American Shoulder and Elbow Surgeons (ASES) scoring system and follow-up data were obtained at a mean of ten years (range, four to sixteen years) postoperatively.
Twenty-six of thirty-four shoulders satisfied the limited goals criteria described by Neer et al. The mean active forward elevation improved from 78 degrees preoperatively to 111 degrees postoperatively (p < 0.001). The mean active external rotation improved from 15 degrees preoperatively to 38 degrees postoperatively (p < 0.0001). One patient with a history of four failed rotator cuff repairs had anterosuperior instability develop after surgery. The mean final total ASES score was 67 points (range, 35 to 100 points). Of the sixteen shoulders in patients who could actively elevate the arm to >or=90 degrees preoperatively, fourteen achieved satisfactory results according to the limited goals criteria of Neer et al. Patients who could actively elevate the arm to 90 degrees had significantly better function (mean ASES function score, 31 compared with 23 points; p = 0.05), pain relief (mean ASES pain score, 48 compared with 30 points; p = 0.002), and higher total ASES scores (mean, 80 compared with 54 points; p < 0.001) than the patients who were unable to actively elevate the arm to 90 degrees .
Hemiarthroplasty can provide good long-term results in rotator cuff-deficient patients with glenohumeral arthritis. Patients who have preoperative forward elevation of >or=90 degrees benefit the most. A low complication rate can be expected for this procedure.
半关节成形术是治疗肩袖撕裂关节病以及与巨大肩袖撕裂相关的盂肱关节炎的常用方法；然而，据我们所知，尚未有关于其长期疗效以及影响疗效的术前因素的报道。
31例患有肩袖撕裂关节病或伴有盂肱关节炎的巨大肩袖撕裂的患者共34个肩部接受了半关节成形术，平均年龄为72岁。所有患者的疗效通过直接体格检查并依据Neer等人的有限目标标准进行评估，术后平均随访3.7年。在25个肩部中，采用美国肩肘外科医师（ASES）评分系统测量长期疗效，术后平均随访10年（范围4至16年）。
34个肩部中有26个符合Neer等人描述的有限目标标准。平均主动前屈上举角度从术前的78度提高到术后的111度（p < 0.001）。平均主动外旋角度从术前的15度提高到术后的38度（p < 0.0001）。1例有4次肩袖修复失败史的患者术后出现前上方不稳定。最终ASES总分平均为67分（范围35至100分）。术前能够主动将手臂上举至≥90度的患者中的16个肩部，根据Neer等人的有限目标标准，14个取得了满意的疗效。术前能够主动将手臂上举至90度的患者，其功能（ASES功能评分平均为31分，而不能上举至90度的患者为23分；p = 0.05）、疼痛缓解（ASES疼痛评分平均为48分，而不能上举至90度的患者为30分；p = 0.002）以及ASES总分（平均为80分，而不能上举至90度的患者为54分；p < 0.001）均显著优于无法主动将手臂上举至90度的患者。
半关节成形术可为患有盂肱关节炎的肩袖缺损患者提供良好的长期疗效。术前前屈上举≥90度的患者获益最大。该手术的并发症发生率较低。
