反式肩关节置换术的并发症发生率、再手术率和学习曲线。
Complications rates, reoperation rates, and the learning curve in reverse shoulder arthroplasty.
机构信息
Blue Ridge Bone and Joint, Asheville, NC, USA.
Blue Ridge Bone and Joint, Asheville, NC, USA.
出版信息
J Shoulder Elbow Surg. 2014 Mar;23(3):388-94. doi: 10.1016/j.jse.2013.06.002. Epub 2013 Sep 8.
BACKGROUND
Reverse shoulder arthroplasty (RSA) has ushered a new era in shoulder surgery. However, the results of RSA also described the complication rates associated with the procedure as inordinate and a learning curve associated with the incidence of complications.
METHODS
The records of 112 patients who underwent 114 RSA procedures by the senior author (G.I.G.) were reviewed for complications related to a RSA. Of these, 93 RSA procedures were the primary treatment for the shoulder, and 21 were revisions.
RESULTS
The total complication rate for the entire group was 7%. Complications included 3 periprosthetic fractures, 3 hematomas, 1 acromion fracture, and 1 deep infection. The complication rate was 19% in the revision RSA group and 4.3% in the primary RSA group (P ≤ .02). Complication rates in the initial RSA patients in this series did not differ from the final procedures in this series (P = .96). The total reoperation rate was 5.3%, and was 19% in the revision RSA group vs 2.2% in the primary RSA group (P ≤ .02).
CONCLUSION
Complications and reoperations associated with a RSA, although significant, occurred at much lower rate than in previous reports. This series demonstrates a significant difference in complication rates and reoperation rates between primary and revision RSA. Revision RSA complications and reoperations were far more common than in primary RSA procedures. No evidence of a learning curve related to surgical experience was demonstrated in this series.
背景
反式肩关节置换术（RSA）开创了肩关节手术的新纪元。然而，RSA 的结果也描述了与该手术相关的并发症发生率过高，并且与并发症发生率相关的学习曲线。
方法
对高级作者（G.I.G.）进行的 112 例 114 例 RSA 手术的患者记录进行了回顾，以评估与 RSA 相关的并发症。其中，93 例 RSA 手术是肩部的主要治疗方法，21 例是翻修手术。
结果
整个组的总并发症发生率为 7%。并发症包括 3 例假体周围骨折、3 例血肿、1 例肩峰骨折和 1 例深部感染。翻修 RSA 组的并发症发生率为 19%，初次 RSA 组为 4.3%（P ≤.02）。本系列中初次 RSA 患者的并发症发生率与本系列中的最后一次手术无差异（P =.96）。总再次手术率为 5.3%，翻修 RSA 组为 19%，初次 RSA 组为 2.2%（P ≤.02）。
结论
尽管 RSA 相关的并发症和再次手术发生率很高，但明显低于以往的报告。本系列表明，初次和翻修 RSA 之间的并发症发生率和再次手术率存在显著差异。翻修 RSA 的并发症和再次手术比初次 RSA 手术更为常见。本系列未发现与手术经验相关的学习曲线的证据。
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