Upper Extremities, Schulthess Clinic, Zürich, Switzerland; Hirslanden Clinic, Endoclinic Zürich, Zürich, Switzerland.
Upper Extremities, Schulthess Clinic, Zürich, Switzerland.
J Shoulder Elbow Surg. 2014 Jul;23(7):1028-35. doi: 10.1016/j.jse.2014.02.024.
The aim of this study was to assess the timing and location of cortical bone resorption after total shoulder arthroplasty with an uncemented rectangular stem and investigate its effect on shoulder function up to 5 years after implantation.
Between June 2003 and September 2006, 183 consecutive total shoulder arthroplasties were performed, 133 of which received a cementless rectangular stem as indicated by primary or post-traumatic osteoarthritis (OA). The 5-year postoperative follow-up rate was 80%. Standardized radiographic controls and clinical assessments were performed at 6 weeks, 6 months, and 1, 2, and 5 years.
Twenty-two patients (17%) showed full-thickness cortical bone resorption, 21 of whom were diagnosed with Sperling zone 2 resorption. The maximum craniocaudal distance of full resorption averaged 19.1 mm (range, 5.6-46.7 mm). The median distance progressed significantly from 9.6 mm to 13.8 mm between 6 and 12 months (P = .005). The risk of bone resorption was 3.1 times higher for post-traumatic OA patients than for those with primary OA. The occurrence of bone resorption increased significantly with increasing stem diameters relative to the humeral diameter. There was no significant effect of bone resorption on functional outcome.
Full-thickness cortical bone resorption in the proximal posterolateral humerus after receipt of a cementless rectangular stem has a prevalence of 17%, mostly occurring within the first year after surgery. Risk factors include age, post-traumatic conditions, and larger stem sizes relative to the humerus. This is a radiographic phenomenon without significant impairment of function or need for revision within 5 years after surgery.
本研究旨在评估全肩关节置换术后皮质骨吸收的时间和部位，并探讨其对植入后 5 年肩关节功能的影响。
2003 年 6 月至 2006 年 9 月，连续进行了 183 例全肩关节置换术，其中 133 例为原发性或创伤后骨关节炎（OA），采用非骨水泥矩形柄。术后 5 年随访率为 80%。在 6 周、6 个月、1、2 和 5 年进行了标准化的影像学检查和临床评估。
22 例（17%）患者出现全层皮质骨吸收，其中 21 例诊断为 Sperling 区 2 型吸收。完全吸收的最大颅侧距离平均为 19.1mm（范围，5.6-46.7mm）。从 6 至 12 个月，中位数距离从 9.6mm 显著进展至 13.8mm（P =.005）。创伤后 OA 患者发生骨吸收的风险比原发性 OA 患者高 3.1 倍。与肱骨头直径相比，骨吸收的发生与更大的柄直径显著相关。骨吸收对功能结果无显著影响。
非骨水泥矩形柄植入后肱骨近端后外侧全层皮质骨吸收的发生率为 17%，大多发生在术后 1 年内。危险因素包括年龄、创伤后情况和相对于肱骨头的更大的柄尺寸。这是一种影像学现象，在术后 5 年内无明显功能损害或需要翻修。
