Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
Bone Joint J. 2014 Jul;96-B(7):936-42. doi: 10.1302/0301-620X.96B7.32946.
Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley-Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p < 0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42(°)(sd 30) and 9(°) (sd 15) respectively pre-operatively to 78(°) (sd 39) and 24(°) (sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching. The Bayley-Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time.
基于 Grammont 概念的反向肩关节置换术设计固有的缺点引起了人们对减少内侧化设计和技术的重新兴趣。本研究的目的是评估全约束、少内侧化、Bayley-Walker 假体治疗肩袖缺损伴肩关节炎的反向肩关节置换术 (RSA) 的结果。对 92 例患者（53 名女性和 44 名男性）的 97 例全关节置换术进行回顾性分析，随访平均 50 个月（（25）（24 至 96）。术前牛津肩评分和主观肩值分别从 47（标准差 9）和 24 分（标准差 18）改善至术后 28（标准差 11）和 61（标准差 24）分（p < 0.001）。静息时疼痛平均从 5.3（标准差 2.8）降至 1.5（标准差 2.3）（p < 0.001）。主动前向抬高和外旋的平均角度分别从术前的 42°（标准差 30）和 9°（标准差 15）增加到术后的 78°（标准差 39）和 24°（标准差 17）（p < 0.001）。共有 20 例患者因并发症需要进一步手术；13 例需要更换部件。没有患者出现肩胛骨切迹。Bayley-Walker 假体为有症状的肩袖缺损肩提供可靠的疼痛缓解和合理的功能改善。与其他 RSA 设计相比，它在前向抬高方面提供了适度的改善，但在某种程度上恢复了外旋，并防止了肩胛骨切迹。需要更长的随访时间来评估假体的存活率和随时间推移的临床性能。
