Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, SJH-31, Portland, OR 97239, USA.
J Bone Joint Surg Am. 2011 May 4;93(9):885-92. doi: 10.2106/JBJS.J.00960.
The majority of cases of glenohumeral arthritis in older adults are primary osteoarthritis and treatment algorithms are well defined, with shoulder arthroplasty providing reliable pain relief and functional improvement of satisfactorily duration. In younger adults, however, diagnoses are more complex and arthroplasty outcomes are less durable. Arthroscopy may be useful both as a diagnostic tool for characterizing lesions and as a therapeutic tool for debridement. Arthroscopic debridement is most likely to benefit patients with mild glenohumeral arthritis, small lesions, and involvement of only one side of the glenohumeral joint. Reconstruction of the humeral joint surface may consist of cartilage repair or reconstruction, resurfacing arthroplasty, or arthroplasty with a stemmed component. Patients treated with hemiarthroplasty avoid glenoid implant loosening, but the procedure provides less predictable pain relief than does total shoulder arthroplasty and may lead to increased postoperative glenoid erosion.
大多数老年人的肩关节关节炎为原发性骨关节炎，其治疗方案已明确界定，肩关节置换术可提供可靠的疼痛缓解和令人满意的持续功能改善。然而，在年轻人中，诊断更为复杂，关节置换术的效果持续时间更短。关节镜检查既可用作确定病变特征的诊断工具，也可用作清创的治疗工具。关节镜清创术最有可能使轻度肩关节关节炎、小病变和仅涉及肩关节一侧的患者受益。肱骨头关节表面的重建可包括软骨修复或重建、表面置换术或带柄部件的关节置换术。接受半肩关节置换术的患者可避免肩胛盂植入物松动，但该手术提供的疼痛缓解效果不如全肩关节置换术确定，并且可能导致术后肩胛盂侵蚀增加。
