Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198-1080, USA.
J Shoulder Elbow Surg. 2011 Mar;20(2):315-21. doi: 10.1016/j.jse.2010.05.025. Epub 2010 Sep 21.
Cement penetration problems and/or cement-induced bone necrosis may contribute to glenoid component failures. An all polyethylene component was developed that promotes biologic fixation between radial fins of its central peg and utilizes minimal cement fixation for its peripheral pegs, but it has little published data. We hypothesized better bone presence between the radial fins would be associated with less overall radiolucencies. This study's purpose was to utilize computed tomography (CT) and plain films to assess for bone between the central peg's radial fins and to assess overall component radiolucencies.
Thirty-five of 48 consecutively performed total shoulder arthroplasties (TSA) for primary glenohumeral osteoarthritis were in patients able to participate a minimum 2 years after surgery. All had reamed humeral head bone packed between radial fins of the central peg and minimal cement for the peripheral pegs. Thin cut (0.625 mm) CT scans, standardized plain films, Simple Shoulder Tests (SST), and Constant scores were obtained. A musculoskeletal radiologist calculated Yian CT scores, bone presence between fins on CT, and Lazarus radiolucency scores.
At a mean of 43 months, by CT: 1) better Yian scores correlated with more bone between fins, and 2) bone was present in 6/6 inter-fin compartments in 23/35 shoulders, averaging 4.5/6 overall. Mean Lazarus radiolucency score was 0.45. Mean SST and Constant scores were 10.3 and 81.3, respectively.
TSA utilizing autologous bone in inter-fin compartments of the central peg and minimal peripheral peg cement maintained bone presence a minimum 2 years post-op. More bone imparted fewer overall component radiolucencies.
水泥渗透问题和/或水泥诱导的骨坏死可能导致肩胛盂部件失效。开发了一种全聚乙烯部件,该部件促进了其中心钉的辐条之间的生物固定,并利用最小的水泥固定其外围钉,但发表的数据很少。我们假设辐条之间的骨存在更好,整体射线不透明度会更低。本研究的目的是利用计算机断层扫描(CT)和普通射线照片来评估中心钉的辐条之间的骨,并评估整体组件射线不透明度。
48 例连续进行的全肩关节置换术(TSA)中,有 35 例原发性肩袖关节炎患者在术后至少 2 年能够参与研究。所有患者的肱骨头均用骨水泥填充在中心钉的辐条之间,而外围钉则用少量骨水泥固定。进行薄层(0.625 毫米)CT 扫描、标准的普通射线照片、简单肩部测试(SST)和Constant 评分。一名肌肉骨骼放射科医生计算了 Yian CT 评分、CT 上辐条之间的骨存在情况以及 Lazarus 射线不透明度评分。
在平均 43 个月时,通过 CT:1)更好的 Yian 评分与更多的辐条之间的骨相关,2)在 35 个肩部中的 23 个中,6/6 个辐条之间的间隙中存在骨,总体平均为 4.5/6。平均 Lazarus 射线不透明度评分为 0.45。平均 SST 和 Constant 评分为 10.3 和 81.3。
在中心钉的辐条之间和最小的外围钉水泥中利用自体骨进行 TSA,术后至少 2 年保持了骨存在。更多的骨会产生更少的整体组件射线不透明度。