Maison Blanche Teaching Hospital Center, Department of Orthopaedic Surgery and traumatology, 45, rue Cognacq-Jay, 51100 Reims, France.
Orthop Traumatol Surg Res. 2010 May;96(3):208-15. doi: 10.1016/j.otsr.2010.01.001. Epub 2010 Apr 7.
Humeral head replacement is used for glenohumeral osteoarthritis in young or active patients, for conditions sparing glenoid cartilage or when glenoid implantation does not appear feasible. These surgical procedures usually give satisfactory results but there is a risk of glenoid erosion and a possible deterioration of long-term outcomes.
There is a risk of glenoid erosion after humeral head replacement which can be radiographically measured. The importance and progression of this erosion should be evaluated to determine its clinical relevance.
This is a retrospective study in 15 patients (19 shoulders) who underwent humeral head replacement between 1999 and 2006. There were 11 women and four men with an average age of 54.5 years. Etiologies were avascular necrosis (11 cases) and glenohumeral osteoarthritis (eight cases). All patients were reviewed in 2008 with more than two years follow-up. Clinical evaluation included measurements of range of motion and determination of the Constant and Murley score. In addition, the patients were asked to provide a subjective evaluation of their shoulder. Radiographic analysis included computer-assisted measurements.
The average follow-up was 45.8 months (26-108). At one year postoperative and at the final follow-up, clinical parameters such as the Constant and Murley score (37.4/100 preoperative to 64.4/100 at final follow-up) were significantly increased. During the first year, the rate of glenoid wear was 1.03 mm/year in case of avascular necrosis and 0.27 mm/year in case of osteoarthritis (p<0.001). Glenoid depth at the final follow-up was 6.97 mm for osteoarthritis compared to 4.59 mm for avascular necrosis (p<0.01). We did not find any correlation between glenoid erosion severity and clinical results.
Isolated humeral head replacement may result in glenoid erosion. The rate of progression of this erosion is clearly influenced by the etiology and therefore by the preexisting condition of the glenoid cartilage. At the average follow-up, the radiological glenoid deterioration is not correlated with pain or deterioration of clinical results.
Level IV. Therapeutic study.
肱骨头置换术用于年轻或活跃患者的肩关节炎，用于保留肩盂软骨的情况，或当肩盂植入似乎不可行时。这些手术通常会取得满意的效果，但存在肩盂侵蚀的风险，并且可能会导致长期结果恶化。
肱骨头置换后存在肩盂侵蚀的风险，可以通过影像学测量。应该评估这种侵蚀的重要性和进展，以确定其临床相关性。
这是一项回顾性研究，共纳入 1999 年至 2006 年间接受肱骨头置换的 15 名患者（19 个肩）。其中 11 名女性和 4 名男性，平均年龄 54.5 岁。病因包括：缺血性坏死（11 例）和肩关节炎（8 例）。所有患者于 2008 年进行了复查，随访时间均超过 2 年。临床评估包括运动范围测量和Constant-Murley 评分的测定。此外，患者还对其肩部进行了主观评估。影像学分析包括计算机辅助测量。
平均随访时间为 45.8 个月（26-108）。术后 1 年和末次随访时，Constant-Murley 评分等临床参数（术前 37.4/100 分至末次随访时 64.4/100 分）显著提高。在最初的 1 年内，缺血性坏死组的肩盂磨损率为每年 1.03mm，而骨关节炎组为每年 0.27mm（p<0.001）。末次随访时，骨关节炎组的肩盂深度为 6.97mm，而缺血性坏死组为 4.59mm（p<0.01）。我们未发现肩盂侵蚀严重程度与临床结果之间存在任何相关性。
单纯肱骨头置换可能导致肩盂侵蚀。这种侵蚀的进展速度显然受到病因的影响，因此也受到肩盂软骨的原有状况的影响。在平均随访时，影像学上的肩盂恶化与疼痛或临床结果的恶化无关。
IV 级。治疗研究。
