Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2014 Mar;23(3):395-400. doi: 10.1016/j.jse.2013.07.047. Epub 2013 Oct 12.
Reverse total shoulder arthroplasty (RTSA) has been indicated primarily for patients aged older than 65 years with symptomatic rotator cuff deficiency, poor function, and pain. However, conditions that benefit from RTSA are not restricted to an elderly population. This study evaluates a consecutive series of RTSA patients aged younger than 60 years.
We evaluated 36 shoulders (mean age, 54 years) at a mean follow-up of 2.8 years (range, 24-48 months). Of these shoulders, 30 (83%) had previous surgery, averaging 2.5 procedures per patient. The preoperative conditions compelling RTSA were as follows: failed rotator cuff repair (12), fracture sequelae (11), failed arthroplasty (5), instability sequelae (4), cuff tear arthropathy (CTA) (4), and rheumatoid arthritis (2). Follow-up examinations included range-of-motion and strength testing, as well as Single Assessment Numeric Evaluation, visual analog scale, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Preoperative and postoperative radiographs were reviewed for component loosening and scapular notching. Failure criteria were defined as undergoing revision, having gross loosening, or having an ASES score below 50.
The mean Single Assessment Numeric Evaluation score improved from 24.4 to 72.0; the visual analog scale pain score improved from 6 to 2.1. The Simple Shoulder Test score improved from 1.4 to 6.2, and the ASES score improved from 31.4 to 65.8. Active forward elevation improved from 56° to 121°. The normalized postoperative mean Constant score was 54.3. In 9 patients (25.0%), we recorded an ASES score below 50, and these cases were considered failures.
RTSA can improve shoulder function in a younger, complex patient population with poor preoperative functional ability. This study's success rate was 75% at 2.8 years. This is a limited-goals procedure, and longer-term studies are required to determine whether similar results are maintained over time.
反向全肩关节置换术（RTSA）主要适用于 65 岁以上、有症状的肩袖缺损、功能差和疼痛的患者。然而，受益于 RTSA 的情况并不局限于老年人群。本研究评估了一组连续的 60 岁以下 RTSA 患者。
我们评估了 36 例肩部（平均年龄 54 岁），平均随访 2.8 年（24-48 个月）。这些肩部中，30 例（83%）有既往手术史，平均每位患者有 2.5 次手术。行 RTSA 的主要术前情况如下：肩袖修复失败（12 例）、骨折后遗症（11 例）、人工关节置换失败（5 例）、不稳定后遗症（4 例）、肩袖撕裂性关节炎（CTA）（4 例）和类风湿关节炎（2 例）。随访检查包括活动范围和力量测试，以及单一评估数字评估、视觉模拟评分、简单肩部测试、美国肩肘外科医生（ASES）和常数评分。对术前和术后的 X 线片进行了检查，以评估有无组件松动和肩胛切迹。失败标准定义为行翻修术、有明显松动或 ASES 评分低于 50。
平均单一评估数字评估评分从 24.4 分提高到 72.0 分；视觉模拟评分疼痛评分从 6 分提高到 2.1 分。简单肩部测试评分从 1.4 分提高到 6.2 分，ASES 评分从 31.4 分提高到 65.8 分。主动前屈从 56°提高到 121°。术后标准化平均常数评分为 54.3。9 例（25.0%）患者的 ASES 评分低于 50，这些病例被认为是失败。
RTSA 可以改善功能较差的年轻、复杂患者群体的肩部功能。本研究在 2.8 年时的成功率为 75%。这是一种有限目标的手术，需要进行长期研究以确定是否随着时间的推移保持类似的结果。
