Flurin Pierre-Henri, Janout Martin, Roche Christopher P, Wright Thomas W, Zuckerman Joseph
Bull Hosp Jt Dis (2013). 2013;71 Suppl 2:68-76.
Loosening of the glenoid component is a frequent cause of failure of total shoulder arthroplasty (TSA). The etiology of glenoid component loosening is multifactorial and includes aseptic osteolysis, rotator cuff insufficiency, soft tissue instability, and infection. A loose glenoid component is frequently associated with a substantial loss of glenoid bone, which necessitates additional procedures to implant a new component. Several studies have shown that patients with a new glenoid component have better clinical outcomes, which makes successful glenoid reimplantation a priority. The reconstructive options when facing a loose glenoid component in anatomic total shoulder arthroplasty include the established techniques of reaming the high side or bone grafting the deficient glenoid combined with a one or two stage revision. Augmented glenoid components may allow surgeons to limit eccentric reaming or the extent of bone grafting necessary in a bone deficient glenoid. The reverse total shoulder arthroplasty (rTSA) is emerging as a useful reconstructive option capable of addressing bony and soft tissue problems encountered in revision TSA. The ream-and-run procedure remains the least desirable option in the face of significant glenoid bone deficiency. The increasing use of augmented glenoids and rTSA in revision TSA may provide opportunities for new areas of clinical outcomes research in this challenging reconstructive problem.
肩胛盂假体松动是全肩关节置换术（TSA）失败的常见原因。肩胛盂假体松动的病因是多因素的，包括无菌性骨溶解、肩袖功能不全、软组织不稳定和感染。松动的肩胛盂假体常伴有肩胛盂骨量的大量丢失，这就需要额外的手术来植入新的假体。多项研究表明，植入新肩胛盂假体的患者临床疗效更佳，这使得成功进行肩胛盂再次植入成为当务之急。在解剖型全肩关节置换术中，面对松动的肩胛盂假体时的重建选择包括传统的高侧扩孔或对肩胛盂缺损处进行植骨并结合一期或二期翻修技术。增强型肩胛盂假体可能使外科医生在骨量不足的肩胛盂中限制偏心扩孔或减少必要的植骨范围。反向全肩关节置换术（rTSA）正逐渐成为一种有用的重建选择，能够解决翻修TSA中遇到的骨和软组织问题。面对严重的肩胛盂骨缺损，扩孔并保留假体的手术仍然是最不理想的选择。在翻修TSA中越来越多地使用增强型肩胛盂和rTSA可能为这一具有挑战性的重建问题的临床疗效研究新领域提供机会。
