Raiss Patric, Kasten Philip, Baumann Florian, Moser Michael, Rickert Markus, Loew Markus
Orthopaedic Department, University of Heidelberg, Heidelberg, Germany.
J Bone Joint Surg Am. 2009 Feb;91(2):340-9. doi: 10.2106/JBJS.H.00560.
Osteonecrosis of the humeral head is a disabling condition that can lead to joint destruction with persistent pain and dysfunction. The aim of the present study was to examine cementless humeral surface replacement arthroplasty as a treatment option for posttraumatic and nontraumatic osteonecrosis.
Between 2002 and 2005, seventeen shoulders with posttraumatic (n = 8) or nontraumatic (n = 9) osteonecrosis of the humeral head were treated with cementless humeral replacement arthroplasty. The mean proportion of the humeral head that was occupied by necrotic bone was 18.6% (range, 8.9% to 30.9%). The mean duration of follow-up was three years. Constant scores, patient satisfaction, and complications were recorded. Volumetric measurements of the necrotic areas and signs of implant loosening were analyzed with use of standardized radiographs.
The mean Constant score for the entire cohort improved significantly from 31 to 62 points (34% to 75% when adjusted by age and sex) (p < 0.0001). There were also significant improvements in mean shoulder flexion (from 87 degrees to 139 degrees), abduction (from 64 degrees to 120 degrees), and external rotation (from 2 degrees to 27 degrees). The final values for the Constant score, abduction, and power were significantly higher for the nontraumatic group than for the posttraumatic group. Fourteen patients (fifteen shoulders) were very satisfied (eleven shoulders) or satisfied (four shoulders), and two patients (two shoulders) were somewhat disappointed with the postoperative result. Signs of implant loosening were not observed. One patient had a wound infection that required surgical débridement and antibiotic therapy. To date, no implant revisions have been necessary.
Cementless humeral surface replacement arthroplasty is a potentially bone-preserving option for patients with posttraumatic and nontraumatic osteonecrosis of the humeral head. Even in the presence of bone loss of as much as 31% of the humeral head, implant loosening was not observed. Good functional results and relief of pain in combination with a low complication rate can be achieved in the short term.
肱骨头坏死是一种致残性疾病，可导致关节破坏，并伴有持续疼痛和功能障碍。本研究的目的是探讨非骨水泥型肱骨头表面置换术作为创伤性和非创伤性肱骨头坏死的一种治疗选择。
2002年至2005年间，对17例创伤性（n = 8）或非创伤性（n = 9）肱骨头坏死患者行非骨水泥型肱骨头置换术。坏死骨占据肱骨头的平均比例为18.6%（范围为8.9%至30.9%）。平均随访时间为3年。记录Constant评分、患者满意度及并发症情况。利用标准化X线片分析坏死区域的体积测量结果及植入物松动迹象。
整个队列的平均Constant评分从31分显著提高至62分（经年龄和性别校正后从34%提高至75%）（p < 0.0001）。平均肩关节前屈（从87度至139度）、外展（从64度至120度）和外旋（从2度至27度）也有显著改善。非创伤组的Constant评分、外展及力量的最终值显著高于创伤组。14例患者（15个肩关节）对术后结果非常满意（11个肩关节）或满意（4个肩关节），2例患者（2个肩关节）对术后结果有些失望。未观察到植入物松动迹象。1例患者发生伤口感染，需要手术清创和抗生素治疗。迄今为止，无需进行植入物翻修。
非骨水泥型肱骨头表面置换术对于创伤性和非创伤性肱骨头坏死患者而言是一种潜在的保留骨的选择。即使肱骨头骨丢失多达31%，也未观察到植入物松动。短期内可获得良好的功能结果、疼痛缓解且并发症发生率低。
