Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2013 Feb;22(2):253-60. doi: 10.1016/j.jse.2012.04.019. Epub 2012 Aug 25.
There is a lack of consensus in treating glenohumeral arthritis in younger patients. Hemiarthroplasty has historically been favored because of complications associated with total shoulder arthroplasty. Biologic resurfacing of the glenoid has been investigated as a potential treatment that would decrease glenoid erosion and pain, the major complications of hemiarthroplasty.
We report on 19 shoulders treated with meniscal allograft glenoid resurfacing and shoulder hemiarthroplasty. All patients were followed up for a minimum of 2 years postoperatively (mean, 4.25 years) with Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test (SST), and visual analog scale (VAS) scores. In addition, we compared the outcomes related to preoperative concentric versus eccentric glenoid wear.
At final follow-up, the mean score for the DASH questionnaire was 28; SST, 8; and VAS, 3.5. Whereas the eccentric wear group (DASH score, 19.4; SST score, 9.1; VAS score, 2.5) exhibited better shoulder function and pain scores compared with the concentric wear group (DASH score, 37.6; SST score, 8.4; VAS score, 4.1), the difference was not statistically significant (P = .098, P = .647, and P = .198, respectively). There were 6 complications (32%), all resulting in repeat surgery. Three patients underwent total shoulder arthroplasty and one shoulder had revision hemiarthroplasty, whereas synovectomy was performed in another shoulder. The sixth patient underwent lysis of adhesions and capsular release.
With long-term follow-up, we have observed that biologic resurfacing of the glenoid with meniscal allograft exhibits inconsistent results and high complication rates. Strong consideration should be given to performing total shoulder arthroplasty in patients in whom all conservative treatment options have failed.
在治疗年轻患者的盂肱关节炎方面，目前尚无共识。由于全肩关节置换术相关的并发症，历史上一直倾向于采用半关节成形术。为了减少半关节成形术的主要并发症——盂肱关节的侵蚀和疼痛，人们研究了生物性肩胛盂表面置换术。
我们报告了 19 例接受半月板同种异体移植物肩胛盂表面置换和肩关节半关节成形术治疗的患者。所有患者均至少随访 2 年（平均随访 4.25 年），随访评估包括臂肩手功能障碍（DASH）评分、简易肩测试（SST）评分和视觉模拟评分（VAS）。此外，我们比较了术前盂肱关节的同心性或偏心性磨损与术后结果的相关性。
末次随访时，DASH 问卷平均评分为 28 分，SST 平均评分为 8 分，VAS 平均评分为 3.5 分。与偏心性磨损组（DASH 评分 19.4 分，SST 评分 9.1 分，VAS 评分 2.5 分）相比，同心性磨损组（DASH 评分 37.6 分，SST 评分 8.4 分，VAS 评分 4.1 分）的肩关节功能和疼痛评分更好，但差异无统计学意义（P=0.098、P=0.647 和 P=0.198）。共有 6 例（32%）出现并发症，均需再次手术。其中 3 例接受了全肩关节置换术，1 例接受了肩关节翻修术，1 例接受了滑膜切除术，1 例接受了粘连松解和囊切开术。
通过长期随访，我们发现半月板同种异体移植物生物性肩胛盂表面置换的效果不一致，并发症发生率较高。对于所有保守治疗方法均失败的患者，应强烈考虑行全肩关节置换术。
