Wiedemann E
OCM Klinik München, Steinerstr. 6, 81369, München, Deutschland.
Orthopade. 2013 Jul;42(7):483-9. doi: 10.1007/s00132-012-2018-4.
Modern shoulder prostheses adapt to the size, inclination, posterior offset and retrotorsion of the shoulder anatomy. Typical implants are cup prostheses for surface replacement, stemless prostheses that anchor in metaphyseal bone, anatomical prostheses using stems of different lengths, and last but not least reverse prostheses. The main reasons for implantation of shoulder prostheses are primary osteoarthritis, posttraumatic and rheumatoid arthritis, avascular necrosis, arthritis of instability and cuff defect arthropathy.Anatomical hemiprostheses should be used only if the glenoid is intact as total prostheses are functionally better as soon as the arthritis involves the glenoid. Conventional stems are cemented most of the time and cemented glenoids that are convex on the back are standard. Stemless prostheses were developed for posttraumatic indications and can often replace stemmed designs if the bone quality is good. Reverse prostheses were developed for the treatment of cuff tear arthropathies but if used as a revision implant complication rates rise and survival time is shorter.
现代肩部假体可适应肩部解剖结构的大小、倾斜度、后方偏移和后倾扭转。典型的植入物包括用于表面置换的杯状假体、锚固于干骺端骨的无柄假体、使用不同长度柄的解剖型假体，以及最后但同样重要的反置假体。植入肩部假体的主要原因是原发性骨关节炎、创伤后和类风湿性关节炎、缺血性坏死、不稳定关节炎和肩袖缺损性关节病。仅当关节盂完整时才应使用解剖型半关节假体，因为一旦关节炎累及关节盂，全关节假体在功能上会更好。传统的柄大多数情况下是骨水泥固定的，而后方凸起的骨水泥固定关节盂是标准配置。无柄假体是为创伤后适应证而开发的，如果骨质良好，通常可以替代有柄设计。反置假体是为治疗肩袖撕裂性关节病而开发的，但如果用作翻修植入物，并发症发生率会上升且生存时间会缩短。
