Mayo Clinic, Rochester, MN, USA.
Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2014 Jun;23(6):791-9. doi: 10.1016/j.jse.2013.09.016. Epub 2013 Dec 4.
This is an update on a previously documented cohort of patients who underwent shoulder arthroplasty for rheumatoid arthritis, with a minimum 5-year clinical follow-up.
The survivorship of 303 consecutive shoulder arthroplasties (108 hemiarthroplasties, 195 total shoulder arthroplasties) for rheumatoid arthritis at one institution was assessed. There were 255 arthroplasties in the clinical analysis and 188 in the radiographic analysis.
Kaplan-Meier survivorship free of revision at 5 years and 10 years was 96.1% and 92.9% for total shoulder arthroplasty (TSA) and 89.2% and 87.9% for hemiarthroplasty (HA). The most common indications were glenoid loosening (5%) and infection (2%) for TSA revision and glenoid arthrosis (7%) for HA revision. Pain relief was greater with TSA than with HA. In patients with an intact rotator cuff, in comparing TSA with HA, those with a TSA had greater improvements in pain scores (-2.7 vs. -1.8 on a 5-point scale) and degrees of elevation (45 versus 24) (P = .08). Approximately 30% of humeral components and 73% of glenoid components had periprosthetic lucencies. There was a shift in position of the glenoid in 33% of TSAs, and 36% were "at risk." Eighty-one percent of HAs had moderate or severe glenoid erosion.
DISCUSSION/CONCLUSION: Both HA and TSA provide pain relief and improved motion in patients with rheumatoid arthritis. In patients with an intact rotator cuff, pain relief and range of motion are more improved with TSA compared with HA. There is a high rate of component lucency, but component revision is uncommon.
Level IV, case series, treatment study.
这是对先前报道的一组接受肩关节炎成形术治疗类风湿关节炎患者的更新，随访时间至少为 5 年。
在一个机构中评估了 303 例连续的肩关节炎成形术（108 例半肩成形术，195 例全肩成形术）治疗类风湿关节炎的存活率。临床分析中有 255 例关节成形术，放射学分析中有 188 例。
Kaplan-Meier 无翻修生存率，全肩关节炎成形术（TSA）为 5 年和 10 年分别为 96.1%和 92.9%，半肩关节炎成形术（HA）为 89.2%和 87.9%。TSA 翻修最常见的指征是肩盂松动（5%）和感染（2%），HA 翻修最常见的指征是肩盂关节炎（7%）。与 HA 相比，TSA 能更好地缓解疼痛。在肩袖完整的患者中，与 HA 相比，TSA 患者的疼痛评分（5 分制，-2.7 分比-1.8 分）和抬举角度（45 度比 24 度）均有更大改善（P =.08）。约 30%的肱骨组件和 73%的肩盂组件有假体周围透亮区。33%的 TSA 出现肩盂位置改变，36%处于“高危”状态。81%的 HA 有中度或重度肩盂侵蚀。
讨论/结论：HA 和 TSA 均能为类风湿关节炎患者提供疼痛缓解和运动改善。在肩袖完整的患者中，与 HA 相比，TSA 能更显著地缓解疼痛和改善活动度。假体周围透亮区发生率较高，但假体翻修并不常见。
IV 级，病例系列，治疗研究。
