Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Shoulder Elbow Surg. 2011 Dec;20(8):1255-64. doi: 10.1016/j.jse.2011.01.024. Epub 2011 Apr 11.
This study was conducted to test the hypothesis that patients would have improved pain and range of motion after conversion total shoulder arthroscopy but that overall outcome would be substantially affected by the need for removal of the humeral component and associated alterations of bony anatomy or soft tissue deficiencies.
Thirty-four patients (34 shoulders) with HHR after a proximal humeral fracture underwent revision total shoulder arthroplasty for painful glenoid arthrosis, with mean follow-up of 9.4 years (range, 2.3-20.4 years). After initial review, repeat analysis was performed based on the complexity of osseous (humeral stem revision) and soft tissue management, including rotator cuff tear, greater tuberosity resorption, malunion or nonunion, or instability.
Overall, patients had reduction in pain (P = .0001), and improved active abduction (P = .05) and external rotation (P = .0005). Less improvement in active abduction was documented in patients who required soft tissue management (P = .03). Results of the modified Neer rating documented 3 excellent, 9 satisfactory, and 22 unsatisfactory results (motion deficiencies in 14). Kaplan-Meier survival analysis free of repeat revision was 100% at 1 year, 96.8% at 5 years (95% confidence interval, 90%-100%), and 92.2% at 10 years (95% confidence interval, 82% to 100%).
Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary HHR for a proximal humeral fracture, with or without the need to change the humeral component. However, active motion may not improve in patients with rotator cuff tearing, a greater tuberosity nonunion, malunion, or resorption.
本研究旨在验证以下假设，即患者在接受全肩关节镜下翻修手术后疼痛和活动范围会得到改善，但总体结果会受到需要移除肱骨头组件以及相关的骨解剖结构改变或软组织缺陷的实质性影响。
34 例（34 肩）肱骨头近端骨折后出现高位肩肱关节（HHR）的患者因肩峰下关节骨关节炎行全肩关节翻修术，平均随访 9.4 年（范围，2.3-20.4 年）。初次评估后，根据骨质（肱骨头干翻修）和软组织管理的复杂性，包括肩袖撕裂、大结节吸收、畸形愈合或不愈合或不稳定，再次进行分析。
总体而言，患者疼痛减轻（P =.0001），主动外展（P =.05）和外旋（P =.0005）改善。需要软组织管理的患者主动外展改善较少（P =.03）。改良 Neer 评分结果记录为 3 个优，9 个良，22 个可（14 个运动功能不足）。无重复翻修的 Kaplan-Meier 生存分析 1 年时为 100%，5 年时为 96.8%（95%置信区间，90%-100%），10 年时为 92.2%（95%置信区间，82%-100%）。
对于肱骨头近端骨折后初次 HHR 出现的疼痛性肩峰下关节骨关节炎，行全肩关节镜下翻修术是有效的，无论是否需要更换肱骨头组件。然而，对于肩袖撕裂、大结节不愈合、畸形愈合或吸收的患者，主动运动可能不会改善。
