Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
J Shoulder Elbow Surg. 2010 Jun;19(4):588-95. doi: 10.1016/j.jse.2009.09.012. Epub 2009 Dec 29.
This study analyzed clinical, radiographic, and histologic data from failed total shoulder arthroplasties (TSAs) to determine factors associated with osteolysis.
From 1985 to 2005, 52 patients (mean age, 61.6 years) underwent revision TSA at a single institution at a mean of 4.3 years after their index surgery. Patients were retrospectively assigned to 2 cohorts based on the presence (n = 10) or absence (n = 42) of osteolysis around their implants on the last prerevision surgery radiographs. Clinical information, associated histopathology from tissues obtained at revision surgery, and polyethylene wear data from the retrieved glenoid components were compared between groups.
In the osteolysis group, 20% had screw fixation compared with 2.5% without osteolysis (P = .039). The radiolucency score was significantly higher in the osteolysis group: 12.7 +/- 2.0 vs 8.7 +/- 3.7 (P = .003). Wear analysis of the osteolysis group demonstrated significant increases in third-body particles compared with those implants without osteolysis (P = .004). Histology available from retrieved implants demonstrated particulate debris in 62% of patients with osteolytic lesions vs 67% without osteolytic lesions (P > .05).
Significant differences were found in patients with osteolytic lesions compared with patients undergoing TSA revision surgery without such lesions, specifically with regard to glenoids that used adjuvant screw fixation, the presence of increased radiolucent lines, and an abundance of third-body wear. No significant differences were found in particulate wear debris despite the prevailing notion that osteolysis is associated with particulate debris from implant wear.
Screw fixation and third-body wear were associated with osteolysis after TSA.
本研究分析了失败的全肩关节置换术（TSA）的临床、影像学和组织学数据，以确定与骨溶解相关的因素。
1985 年至 2005 年，在一家机构中，52 名患者（平均年龄 61.6 岁）在其初次手术 4.3 年后接受了翻修 TSA。根据最后一次术前手术 X 光片上是否存在（n=10）或不存在（n=42）植入物周围的骨溶解，将患者回顾性地分为 2 组。比较了两组之间的临床信息、翻修手术时获得的组织的相关组织病理学以及从取出的肩胛盂组件获得的聚乙烯磨损数据。
在骨溶解组中，20%的患者有螺钉固定，而无骨溶解组为 2.5%（P=0.039）。骨溶解组的透光率评分明显较高：12.7±2.0 与 8.7±3.7（P=0.003）。骨溶解组的磨损分析显示，与无骨溶解的植入物相比，第三体颗粒显著增加（P=0.004）。从取出的植入物获得的组织学显示，在有骨溶解病变的患者中，62%有颗粒性碎片，而在没有骨溶解病变的患者中，67%有颗粒性碎片（P＞0.05）。
与接受 TSA 翻修手术但无此类病变的患者相比，有骨溶解病变的患者存在显著差异，具体表现在使用辅助螺钉固定的肩胛盂、存在更多的透光线以及大量的第三体磨损。尽管普遍认为骨溶解与植入物磨损产生的颗粒性磨损有关，但在颗粒性磨损碎屑方面未发现显著差异。
螺钉固定和第三体磨损与 TSA 后骨溶解有关。
