Scalise Jason J, Iannotti Joseph P
The CORE Institute, 3010 West Agua Fria Freeway, Suite 100, Phoenix, AZ 85027, USA.
J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:30-7. doi: 10.2106/JBJS.H.01249.
While there have been numerous reports concerning glenohumeral arthrodesis for many indications, there is little available information specific to glenohumeral arthrodesis performed after failed prosthetic shoulder arthroplasty. The purpose of this study was to report the outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral bone loss and deltoid muscle and rotator cuff insufficiency following failed prosthetic shoulder arthroplasty.
We retrospectively reviewed clinical and radiographic data on seven consecutive patients treated with glenohumeral arthrodesis following a failed prosthetic shoulder arthroplasty between 1997 and 2004. The average duration of clinical follow-up was four years (range, 1.5 to eight years).
Five of the seven patients demonstrated an intact fusion at the time of the latest follow-up. Four of the seven patients had undergone additional bone-grafting procedures in an effort to obtain union. Two of these patients ultimately had a persistent nonunion despite the additional procedures for bone-grafting and revision of the fixation hardware. Overall, the average subjective clinical outcome score (Penn Shoulder Score) improved significantly from 17 points (range, 8 to 33 points) to 58 points (range, 31 to 77 points) (p = 0.008). The most common complication was delayed union requiring additional procedures for bone-grafting and revision of the fixation hardware.
Treatment of a failed prosthetic shoulder arthroplasty with concomitant extensive glenohumeral bone loss and soft-tissue deficiencies is extremely challenging. The results of this study suggest that glenohumeral arthrodesis can yield satisfactory clinical outcomes. However, both the patient and the surgeon should be aware of the complex nature of this surgery and the frequent need for additional surgical procedures to obtain fusion.
虽然已有众多关于多种适应证的盂肱关节融合术的报道，但针对假体肩关节置换失败后进行的盂肱关节融合术的具体信息却很少。本研究的目的是报告在假体肩关节置换失败后，伴有严重盂肱关节骨质丢失、三角肌和肩袖功能不全的情况下，盂肱关节融合术的结果。
我们回顾性分析了1997年至2004年间连续7例假体肩关节置换失败后接受盂肱关节融合术患者的临床和影像学资料。临床随访的平均时间为4年（范围1.5至8年）。
7例患者中有5例在最近一次随访时显示融合完整。7例患者中有4例接受了额外的植骨手术以促进愈合。尽管进行了额外的植骨手术和固定器械翻修，但其中2例患者最终仍持续不愈合。总体而言，主观临床结果评分（宾夕法尼亚肩关节评分）从平均17分（范围8至33分）显著提高至58分（范围31至77分）（p = 0.008）。最常见的并发症是延迟愈合，需要进行额外的植骨手术和固定器械翻修。
治疗伴有广泛盂肱关节骨质丢失和软组织缺损的假体肩关节置换失败极具挑战性。本研究结果表明，盂肱关节融合术可产生令人满意的临床结果。然而，患者和外科医生都应意识到该手术的复杂性以及为实现融合经常需要额外的手术操作。
