Shoulder Unit, Department of Orthopaedics and Trauma, Sunderland Royal Hospital, Sunderland, United Kingdom.
J Shoulder Elbow Surg. 2010 Jul;19(5):749-56. doi: 10.1016/j.jse.2009.11.005. Epub 2010 Mar 2.
We believe the variable reported survivorship of the metal-backed glenoid is related to the design of the component. This study reports the outcome and survivorship of the uncemented glenoid in rheumatoid patients with an intact or repairable rotator cuff at surgery, and considers the key design features that may predict longevity of this component.
Forty-six shoulders in 39 patients (31 women), with a mean age of 55 years (range, 35-86 years) received a total shoulder replacement with a screw-fixed porous coated metal-back glenoid. Twenty-nine patients (36 shoulders) were monitored for a mean of 132 months (96-168 months), and 10 were lost to follow-up or died before 8 years of follow-up. A Constant score was measured preoperatively and annually from the time of surgery. Radiographs were assessed for lucency, loosening, and superior subluxation of the humeral head.
The Constant score improved from a mean of 20.6 preoperatively to 33.5 at last follow-up (P < .001). Implant survivorship at 10 years was 89%. Five were revised: 3 for pain with associated superior subluxation, 1 for infection, and 1 for aseptic loosening. In the 4 patients with lucent zones around the glenoid, superior subluxation of the humeral head had occurred 2 to 4 years before the observed lucent lines.
The uncemented glenoid performs well in the rheumatoid shoulder, giving pain relief and improved functional outcome. The survivorship is comparable to previously reported studies.
We believe the key design features in the survivorship of the metal-backed glenoid are: a low-profile tray, with a fully coated bone ingrowth substance at the plate-bone interface, a conical stem, and secure screw fixation.
我们认为金属背衬肩胛盂报告的存活率差异与组件设计有关。本研究报告了在手术中肩袖完整或可修复的类风湿关节炎患者的非骨水泥肩胛盂的结果和存活率，并考虑了可能预测该组件寿命的关键设计特征。
46 例 39 名患者（31 名女性），平均年龄 55 岁（范围 35-86 岁）接受了带有螺钉固定多孔涂层金属背衬肩胛盂的全肩关节置换术。29 例（36 肩）平均随访 132 个月（96-168 个月），10 例失访或随访 8 年以下死亡。术前和术后每年采用Constant 评分进行测量。评估 X 线片的透亮线、松动和肱骨头向上半脱位。
Constant 评分从术前的 20.6 平均提高到末次随访时的 33.5（P<0.001）。10 年时的植入物存活率为 89%。有 5 例翻修：3 例因疼痛伴相关上半脱位，1 例因感染，1 例因无菌性松动。在 4 例肩胛盂周围有透亮区的患者中，肱骨头向上半脱位发生在观察到透亮线的 2-4 年前。
非骨水泥肩胛盂在类风湿性肩关节中表现良好，可缓解疼痛并改善功能结果。存活率与先前报道的研究相似。
我们认为金属背衬肩胛盂存活率的关键设计特征是：低轮廓托盘，在板骨界面具有完全涂层的骨内生长物质、锥形柄和可靠的螺钉固定。
