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一项关于在原发性骨关节炎肩关节置换中使用平背聚乙烯关节盂组件的长期结果的多中心研究。

A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis.

作者信息

Young A, Walch G, Boileau P, Favard L, Gohlke F, Loew M, Molé D

机构信息

Sydney Shoulder Specialists, Suite 201, Level 2, 156 Pacific Highway, St Leonards, Sydney 2065, Australia.

出版信息

J Bone Joint Surg Br. 2011 Feb;93(2):210-6. doi: 10.1302/0301-620X.93B2.25086.

Abstract

We report the long-term clinical and radiological outcomes of the Aequalis total shoulder replacement with a cemented all-polyethylene flat-back keeled glenoid component implanted for primary osteoarthritis between 1991 and 2003 in nine European centres. A total of 226 shoulders in 210 patients were retrospectively reviewed at a mean of 122.7 months (61 to 219) or at revision. Clinical outcome was assessed using the Constant score, patient satisfaction score and range of movement. Kaplan-Meier survivorship analysis was performed with glenoid revision for loosening and radiological glenoid loosening (SD) as endpoints. The Constant score was found to improve from a mean of 26.8 (SD 10.3) pre-operatively to 57.6 (SD 20.0) post-operatively (p < 0.001). Active forward flexion improved from a mean of 85.3° (SD 27.4) pre-operatively to 125° (SD 37.3) postoperatively (p < 0.001). External rotation improved from a mean of 7° (SD 6.5) pre-operatively to 30.3° (SD 21.8°) post-operatively (p < 0.001). Survivorship with revision of the glenoid component as the endpoint was 99.1% at five years, 94.5% at ten years and 79.4% at 15 years. Survivorship with radiological loosening as the endpoint was 99.1% at five years, 80.3% at ten years and 33.6% at 15 years. Younger patient age and the curettage technique for glenoid preparation correlated with loosening. The rate of glenoid revision and radiological loosening increased with duration of follow-up, but not until a follow-up of five years. Therefore, we recommend that future studies reporting radiological outcomes of new glenoid designs should report follow-up of at least five to ten years.

摘要

我们报告了1991年至2003年间在欧洲9个中心为原发性骨关节炎患者植入骨水泥全聚乙烯平底带龙骨肩胛盂组件的Aequalis全肩关节置换术的长期临床和放射学结果。对210例患者的226个肩关节进行了回顾性分析,平均随访时间为122.7个月(61至219个月)或至翻修时。使用Constant评分、患者满意度评分和活动范围评估临床结果。以肩胛盂翻修松动和放射学肩胛盂松动(标准差)为终点进行Kaplan-Meier生存分析。发现Constant评分从术前平均26.8分(标准差10.3)提高到术后57.6分(标准差20.0)(p<0.001)。主动前屈从术前平均85.3°(标准差27.4)提高到术后125°(标准差37.3)(p<0.001)。外旋从术前平均7°(标准差6.5)提高到术后30.3°(标准差21.8°)(p<0.001)。以肩胛盂组件翻修为终点的5年生存率为99.1%,10年生存率为94.5%,15年生存率为79.4%。以放射学松动为终点的5年生存率为99.1%,10年生存率为80.3%,15年生存率为33.6%。患者年龄较轻以及肩胛盂准备的刮除技术与松动相关。肩胛盂翻修率和放射学松动率随随访时间增加而增加,但直到随访5年后才出现这种情况。因此,我们建议未来报告新型肩胛盂设计放射学结果的研究应报告至少5至10年的随访情况。

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