Ding David Y, Mahure Siddharth A, Akuoko Jaleesa A, Zuckerman Joseph D, Kwon Young W
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Shoulder & Elbow Division, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
J Shoulder Elbow Surg. 2015 Jun;24(6):831-7. doi: 10.1016/j.jse.2015.03.009.
Traditional total shoulder arthroplasty (TSA) involves releasing the subscapularis tendon for exposure. This can potentially lead to subscapularis insufficiency, compromised function, and dissatisfaction. A novel TSA technique preserves the subscapularis tendon by performing the procedure entirely through the rotator interval, allowing accelerated rehabilitation. However, early reports on this approach have noted malpositioning of the humeral component and residual osteophytes. In a randomized trial, we examined the incidence of humeral head malpositioning, incorrect sizing, and residual osteophytes on postoperative radiographs after subscapularis-sparing TSA compared with the traditional approach.
Patients were prospectively randomized to undergo TSA performed through the traditional or subscapularis-sparing approach. The operating surgeon was blinded to the randomization until the day of surgery. Anatomic reconstruction measurements included humeral head height, humeral head centering, humeral head medial offset, humeral head diameter (HHD), and head-neck angle. Two independent reviewers analyzed the postoperative radiographs to determine anatomic restoration of the humeral head and the presence of residual osteophytes.
We randomized 96 patients to undergo either the standard approach (n = 50) or the subscapularis-sparing approach (n = 46). There were no significant differences in humeral head height, humeral head centering, humeral head medial offset, HHD, head-neck angle, and anatomic reconstruction index between the 2 groups. However, significantly more postoperative osteophytes (P = .0001) were noted in the subscapularis-sparing TSA group. Although the overall mean was not statistically different, further analysis of HHD showed that more patients in the subscapularis-sparing TSA group were outliers (mismatch >4 mm) than in the traditional TSA group.
Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing TSA, retained osteophytes and significant mismatch of the HHD raise concerns regarding long-term outcomes.
传统全肩关节置换术（TSA）需要松解肩胛下肌腱以进行显露。这可能会导致肩胛下肌功能不全、功能受损以及患者不满意。一种新型的TSA技术通过完全经旋转间隙进行手术来保留肩胛下肌腱，从而实现加速康复。然而，关于这种方法的早期报告指出存在肱骨假体位置不当和残留骨赘的问题。在一项随机试验中，我们比较了保留肩胛下肌的TSA与传统方法术后X线片上肱骨头位置不当、尺寸错误和残留骨赘的发生率。
患者被前瞻性随机分为接受传统或保留肩胛下肌方法的TSA手术。手术医生在手术当天之前对随机分组情况不知情。解剖重建测量包括肱骨头高度、肱骨头中心位置、肱骨头内侧偏移、肱骨头直径（HHD）和头颈角。两名独立的评估者分析术后X线片以确定肱骨头的解剖复位情况和残留骨赘的存在。
我们将96例患者随机分为接受标准方法组（n = 50）或保留肩胛下肌方法组（n = 46）。两组在肱骨头高度、肱骨头中心位置、肱骨头内侧偏移、HHD、头颈角和解剖重建指数方面无显著差异。然而，保留肩胛下肌的TSA组术后骨赘明显更多（P = .0001）。虽然总体平均值无统计学差异，但对HHD的进一步分析显示，保留肩胛下肌的TSA组中异常值（不匹配>4 mm）的患者比传统TSA组更多。
虽然使用保留肩胛下肌的TSA可以实现肩关节的解剖复位，但残留骨赘和HHD的明显不匹配引发了对长期预后的担忧。
