Institut de la main, Clinique Jouvenet, 6 square Jouvenet, 75016 Paris, France.
Clin Orthop Relat Res. 2011 Sep;469(9):2550-7. doi: 10.1007/s11999-011-1844-8.
Cuff tear arthropathy is the primary indication for total reverse shoulder arthroplasty. In patients with pseudoparalytic shoulders secondary to irreparable rotator cuff tear, reverse shoulder arthroplasty allows restoration of active anterior elevation and painless shoulder. High rates of glenoid notching have also been reported. We designed a new reverse shoulder arthroplasty with a center of rotation more lateral than the Delta prosthesis to address this problem.
QUESTIONS/PURPOSES: Does reduced medialization of reverse shoulder arthroplasty improve shoulder motion, decrease glenoid notching, or increase the risk of glenoid loosening?
We retrospectively reviewed 76 patients with 76 less medialized reverse shoulder prostheses implanted for pseudoparalytic shoulder with rotator cuff deficiency between October 2003 and May 2006. Shoulder motion, Constant-Murley score, and plain radiographs were analyzed. Minimum followup was 24 months (mean, 44 months; range, 24-60 months).
The absolute Constant-Murley score increased from 24 to 59, representing an increase of 35 points. The range of active anterior elevation increased by 61°, and the improvement in pain was 10 points. The gain in external rotation with elbow at the side was 15°, while external rotation with 90° abduction increased by 30°. Followup showed no glenoid notching and no glenoid loosening with these less medialized reverse prostheses.
Less medialization of reverse shoulder arthroplasty improves external and medial rotation, thus facilitating the activities of daily living of older patients. The absence of glenoid notching and glenoid loosening hopefully reflects longer prosthesis survival, but longer followup is necessary to confirm these preliminary observations.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
肩袖撕裂是全反肩关节置换术的主要适应证。对于不可修复的肩袖撕裂导致假性瘫痪的患者，反肩关节置换术可以恢复主动前向抬高和无痛的肩部。也有报道称，肩峰下切迹的发生率很高。为了解决这个问题，我们设计了一种新的反肩关节置换术，其旋转中心比 Delta 假体更靠外侧。
问题/目的：反肩置换术的内侧移位减少是否可以改善肩部运动，减少肩峰下切迹，或增加肩峰松动的风险？
我们回顾性分析了 2003 年 10 月至 2006 年 5 月期间因肩袖缺陷导致假性瘫痪性肩部的 76 例患者的 76 例较少内侧化反肩置换术。分析了肩部运动、Constant-Murley 评分和 X 线平片。随访时间至少为 24 个月（平均 44 个月；范围，24-60 个月）。
绝对 Constant-Murley 评分从 24 分增加到 59 分，增加了 35 分。主动前向抬高的范围增加了 61°，疼痛改善了 10 分。肘部在体侧的外旋增加了 15°，而 90°外展时的外旋增加了 30°。随访时，这些较少内侧化的反假体没有肩峰下切迹，也没有肩峰松动。
反肩置换术的内侧移位减少改善了外旋和内旋，从而提高了老年患者的日常生活能力。没有肩峰下切迹和肩峰松动，有望反映假体的更长生存时间，但需要更长时间的随访来证实这些初步观察。
IV 级，治疗研究。有关完整的证据水平描述，请参见作者指南。
