反式肩关节置换术在类风湿关节炎中能较少并发症吗？
Can reverse shoulder arthroplasty be used with few complications in rheumatoid arthritis?
机构信息
Department of Orthopaedic Surgery, Capio St Görans Hospital, 112 81 Stockholm, Sweden.
出版信息
Clin Orthop Relat Res. 2011 Sep;469(9):2483-8. doi: 10.1007/s11999-010-1654-4.
BACKGROUND
Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar.
QUESTIONS/PURPOSES: We therefore (1) evaluated pain relief and shoulder function after reverse arthroplasty in RA; (2) compared results between primary and revision procedures; (3) determined the incidence of scapular notching; and (4) determined the complication rate.
METHODS
We identified 29 patients with RA who had 33 reverse arthroplasties from among 412 patients having the surgery. Six patients were lost to followup. Twenty three patients (27 shoulders) were evaluated after a minimum followup of 18 months (mean, 56 months; range, 18-143 months), including 18 primary and nine revision arthroplasties. All patients were evaluated preoperatively and 23 shoulders postoperatively by an independent physiotherapist and four were assessed postoperatively by phone. Level of pain, range of motion, and Constant-Murley score were recorded and new radiographs taken.
RESULTS
Visual Analog Scale score for pain decreased from 8.0 to 1.0. Constant-Murley score increased from 13 to 52. Primary procedures had higher scores compared with revisions. Three patients had revision surgery. Notching occurred in 52% of shoulders but no loosening was seen.
CONCLUSIONS
Reverse arthroplasty in rheumatoid arthritis improved shoulder function with a low incidence of complications. We believe it should be considered in elderly patients with rheumatoid arthritis with pain and poor active range of motion resulting from massive cuff tears.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
许多患有类风湿关节炎的患者由于肩袖大量撕裂而导致肱骨头向上迁移，从而丧失主动活动度。反式肩关节置换术有可能恢复生物力学平衡，但已有报道称其肩盂失败的发生率较高。然而，这些研究通常不包括许多类风湿关节炎（RA）患者，并且尚不清楚失败率是否相似。
问题/目的：因此，我们（1）评估了 RA 患者反式关节置换术后的疼痛缓解和肩部功能；（2）比较了原发性和翻修手术的结果；（3）确定了肩胛切迹的发生率；（4）确定了并发症发生率。
方法
我们从 412 例接受手术的患者中确定了 29 例 RA 患者，他们共进行了 33 例反式关节置换术。有 6 例患者失访。在至少 18 个月（平均 56 个月；范围，18-143 个月）的随访后，评估了 23 例患者（27 个肩部），其中包括 18 例原发性和 9 例翻修手术。所有患者均在术前和 23 个肩部术后由独立物理治疗师进行评估，其中 4 个肩部通过电话进行术后评估。记录疼痛程度、活动范围和 Constant-Murley 评分，并拍摄新的 X 线片。
结果
疼痛的视觉模拟量表评分从 8.0 降至 1.0。Constant-Murley 评分从 13 提高到 52。原发性手术的评分高于翻修手术。有 3 例患者进行了翻修手术。肩胛切迹发生率为 52%，但未见松动。
结论
类风湿关节炎的反式关节置换术改善了肩部功能，且并发症发生率较低。我们认为，对于因肩袖大量撕裂而导致疼痛和主动活动范围差的老年 RA 患者，应考虑进行这种手术。
证据水平
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
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