Hattrup Steven J, Sanchez-Sotelo Joaquin, Sperling John W, Cofield Robert H
Department of Orthopedic Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
J Hand Surg Am. 2012 Sep;37(9):1888-94. doi: 10.1016/j.jhsa.2012.05.015. Epub 2012 Jun 30.
Patients with inflammatory arthritis frequently develop destructive shoulder arthritis and rotator cuff tearing. Reconstruction with anatomical shoulder replacement produces lesser results than for other etiologies such as osteoarthritis. We postulated that reconstruction with reverse shoulder prostheses would lead to early satisfactory results for these patients.
We carried out a retrospective review of 19 shoulders treated with reverse shoulder prostheses at a mean follow-up of 37 months. We rated patients' pain using a visual analog pain scale (VAPS) and noted active range of motion in forward elevation, abduction, and external rotation. American Shoulder and Elbow Society and Simple Shoulder Test SST scores were available for 12 patients preoperatively and 16 postoperatively. We graded final results using the modified Neer scale.
Preoperatively, the mean VAPS was 6.5, with average flexion of 68, abduction 66, and external rotation 23°. The American Shoulder and Elbow Society score averaged 27 and the SST 1. Postoperatively, the VAPS was 1 and flexion was 138°, abduction 134°, and external rotation 52°. The mean ASES score increased to 76 and the SST to 8. There were 12 excellent, 5 satisfactory, and 2 unsatisfactory results. Complications included 2 scapular spine fractures, 1 acromial fracture, 1 dislocation, and 1 ulnar neuropathy. We found scapular notching in 42% of the shoulders. Six shoulders had grade 1 notching, and 2 shoulders grade 2 notching. There was no evidence of glenoid loosening, but we saw complete bone-cement radiolucency around 2 cemented stems.
At early follow-up, reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients.
炎性关节炎患者常发生破坏性肩关节关节炎和肩袖撕裂。与骨关节炎等其他病因相比，解剖型肩关节置换重建的效果较差。我们推测，采用反式肩关节假体进行重建对这些患者可带来早期满意的效果。
我们对19例接受反式肩关节假体治疗的患者进行了回顾性研究，平均随访37个月。我们使用视觉模拟疼痛量表（VAPS）对患者的疼痛进行评分，并记录前屈、外展和外旋的主动活动范围。12例患者术前及16例患者术后可获得美国肩肘外科协会（ASES）评分和简单肩关节试验（SST）评分。我们使用改良的Neer量表对最终结果进行分级。
术前，平均VAPS为6.5，平均前屈68°，外展66°，外旋23°。ASES评分平均为27分，SST评分为1分。术后，VAPS为1分，前屈为138°，外展134°，外旋52°。ASES评分平均增至76分，SST评分增至8分。结果为12例优秀，5例满意，2例不满意。并发症包括2例肩胛冈骨折、1例肩峰骨折、1例脱位和1例尺神经病变。我们发现42%的肩关节存在肩胛切迹。6例肩关节为1级切迹，2例肩关节为2级切迹。没有证据表明盂肱关节松动，但我们在2个骨水泥固定柄周围看到了完全的骨水泥透亮区。
在早期随访中，对于因炎性关节炎导致肩袖缺损而受损的肩关节，反式肩关节置换术可为大多数患者带来显著改善。
