Richards R R, Beaton D, Hudson A R
From the Upper Extremity Reconstructive Service, St. Michael's Hospital, Canada; University of Toronto, Toronto, Ontario, Canada.
J Shoulder Elbow Surg. 1993 Sep;2(5):225-39. doi: 10.1016/S1058-2746(09)80081-5. Epub 2009 Feb 19.
Fifty-seven patients underwent shoulder arthrodesis with a single plate. The technique utilized included both glenohumeral and acromiohumeral arthrodesis. A 10-hole plate was used for internal fixation. The position utilized was 30° abduction, 30° internal rotation, and 30° flexion. Forty-six patients underwent the procedure for brachial plexus injury, six patients for multidirectional shoulder instability, two patients for osteoarthritis, two patients for failed total shoulder arthroplasties, and one for infection. The patients were independently reviewed by a research clinician and their function assessed according to their ability to perform activities of daily living, subjective satisfaction with the procedure, and the degree of pain they felt in their shoulder. Fifty-four shoulders fused within 10° of the desired position. Three patients required secondary bone grafting. The complication rate was 14%. Patient satisfaction was highest in those patients undergoing the procedure for brachial plexus injury, osteoarthritis, and failed total shoulder arthroplasty (p = 0.0046). Four patients with multidirectional shoulder instability continued to complain of instability in spite of solid arthrodesis (p < 0.01). The difference in the cumulative activities of daily living score between the brachial plexus injury and poor hand function group and the multidirectional shoulder instability group and patients with other diagnoses was significant (p = 0.0001). Preoperative diagnosis, hand function, and work status were significant determinants of patient satisfaction and the cumulative activities of daily living score (p = 0.0001).
57例患者接受了单钢板肩关节融合术。所采用的技术包括盂肱关节和肩锁关节融合术。使用一块10孔钢板进行内固定。固定位置为外展30°、内旋30°和屈曲30°。46例患者因臂丛神经损伤接受该手术,6例因多方向肩关节不稳定,2例因骨关节炎,2例因全肩关节置换术失败,1例因感染。由一名研究临床医生对患者进行独立评估,并根据他们进行日常生活活动的能力、对手术的主观满意度以及肩部疼痛程度来评估其功能。54个肩关节在期望位置的10°范围内融合。3例患者需要二次植骨。并发症发生率为14%。接受臂丛神经损伤、骨关节炎和全肩关节置换术失败手术的患者满意度最高(p = 0.0046)。4例多方向肩关节不稳定患者尽管关节融合牢固,但仍抱怨存在不稳定(p < 0.01)。臂丛神经损伤和手部功能差的组与多方向肩关节不稳定组以及其他诊断患者之间日常生活活动累积评分的差异具有显著性(p = 0.0001)。术前诊断、手部功能和工作状态是患者满意度和日常生活活动累积评分的重要决定因素(p = 0.0001)。