Sweet Stephan J, Takara Tad, Ho Lance, Tibone James E
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Am J Sports Med. 2015 Mar;43(3):579-87. doi: 10.1177/0363546514562547. Epub 2015 Jan 6.
Humeral head defects such as degenerative disease or avascular necrosis are often treated with stemmed hemiarthroplasty or total shoulder arthroplasty. Despite its historical and clinical significance, stemmed humeral head replacement poses inherent technical challenges to placing spherical implants at the anatomically correct head height, version, and neck-shaft angle.
The aim of this study was to assess humeral head inlay arthroplasty as a joint-preserving alternative that maintains the individual head-neck-shaft anatomy. Humeral head inlay arthroplasty also allows intraoperative surface mapping and placement of a contoured articular component that is matched to the patient's defect size, location, and individual surface geometry.
Case series; Level of evidence, 4.
This retrospective case series included 19 patients (20 shoulders), with an average age of 48.9 years (range, 32-58 years; 16 men, 3 women). Preoperative diagnoses were osteoarthritis in 16 shoulders and osteonecrosis in 4 shoulders. Pre- and postoperative evaluations included physical examination, radiographic assessment, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, the Simple Shoulder Test, a pain visual analog scale, and patient satisfaction rating.
The mean follow-up period was 32.7 months (range, 17-66 months). The mean American Shoulder and Elbow Surgeons score improved from 24.1 to 78.8, mean Simple Shoulder Test score from 3.95 to 9.3, mean visual analog scale score from 8.2 to 2.1, mean forward flexion from 100° to 129°, and mean external rotation from 23° to 43° (P < .001 for all). Radiographic follow-up showed no evidence of periprosthetic fracture, component loosening, osteolysis, or device failure. Patient shoulder self-assessment was 90% poor before surgery and improved to 75% good to excellent at last follow-up; 20% of patients self-rated as somewhat good to somewhat poor, and 5% self-rated as poor. Ninety percent of patients were satisfied with the choice of the procedure. Three patients had postoperative complications unrelated to the implants, including a partial rotator cuff tear treated with physical therapy, preexisting glenoid wear treated with arthroscopic debridement and microfracture, and infection complicated by subscapularis rupture requiring several subsequent surgical procedures but with retention of the implant.
Humeral head inlay arthroplasty is effective in providing pain relief, functional improvement, and patient satisfaction. Rather than delaying shoulder arthroplasty to end-stage osteoarthritis, humeral head inlay arthroplasty is a promising new direction in primary shoulder arthroplasty for younger and active patients with earlier stage disease.
肱骨头缺损，如退行性疾病或缺血性坏死，常采用带柄半关节置换术或全肩关节置换术进行治疗。尽管带柄肱骨头置换术具有历史和临床意义，但在将球形植入物放置在解剖学上正确的头部高度、旋转角度和颈干角方面存在固有的技术挑战。
本研究的目的是评估肱骨头嵌体置换术作为一种保留关节的替代方法，该方法可维持个体的头-颈-干解剖结构。肱骨头嵌体置换术还允许术中进行表面测绘，并放置与患者缺损大小、位置和个体表面几何形状相匹配的异形关节部件。
病例系列；证据等级，4级。
本回顾性病例系列纳入了19例患者（20个肩关节），平均年龄48.9岁（范围32 - 58岁；16例男性，3例女性）。术前诊断为16个肩关节骨关节炎，4个肩关节骨坏死。术前和术后评估包括体格检查、影像学评估、美国肩肘外科医师协会标准化肩关节评估表、简易肩关节试验、疼痛视觉模拟量表和患者满意度评分。
平均随访期为32.7个月（范围17 - 66个月）。美国肩肘外科医师协会平均评分从24.1提高到78.8，简易肩关节试验平均评分从3.95提高到9.3，视觉模拟量表平均评分从8.2降低到2.1，平均前屈从100°增加到129°，平均外旋从23°增加到43°（所有P <.001）。影像学随访未发现假体周围骨折、部件松动、骨溶解或器械故障的证据。患者肩关节自我评估术前90%为差，末次随访时改善为75%为良好至优秀；20%的患者自评稍好至稍差，5%的患者自评差。90%的患者对手术选择满意。3例患者出现与植入物无关的术后并发症，包括1例通过物理治疗的部分肩袖撕裂、1例通过关节镜清创和微骨折治疗的术前存在的关节盂磨损，以及1例感染并发肩胛下肌破裂，需要后续多次手术，但植入物保留。
肱骨头嵌体置换术在缓解疼痛、改善功能和提高患者满意度方面是有效的。肱骨头嵌体置换术并非将肩关节置换术推迟至终末期骨关节炎，而是早期疾病的年轻活跃患者初次肩关节置换术的一个有前景的新方向。
