Alta Tjarco D W, Willems W Jaap
Orthopaedic Clinic "Orthopedium", Delft, The Netherlands.
Orthopaedic Clinic "de Lairesse", Amsterdam, The Netherlands.
J Shoulder Elbow Surg. 2016 Feb;25(2):232-7. doi: 10.1016/j.jse.2015.07.010. Epub 2015 Sep 3.
An arthrodesis of the shoulder is historically a solution for severe shoulder joint problems, for which no prosthetic solution is deemed possible. With the introduction of the reverse shoulder arthroplasty (RSA), which is intrinsically stable at the glenohumeral joint, it seems logical to consider conversion of a painful arthrodesis into a RSA, provided that the deltoid was not destroyed during the arthrodesis.
Four patients (2 men, 2 women; age 46-66 years) with a longstanding arthrodesis (5-11 years) visited our clinic with a painful shoulder (mainly around the scapula) with the request to provide more mobility. In all, the shoulder was fused in 60° to 80° of abduction, 20° to 40° of flexion, and 40° to 50° of internal rotation. All patients refused an osteotomy as treatment for the pain. A preoperative electromyelogram showed activity in at least the posterior or middle parts of the deltoid, or both. They were offered revision of arthrodesis to a reverse prosthesis. All complications, especially instability, were discussed. Surgery was performed through the previous deltopectoral scar. In 3 cases, the osteotomy was lateral to the original joint line, providing some lateralization.
Follow-up was 22 to 60 months. The Constant-Murley score improved from 15-21 to 30-60. No dislocations occurred. All patients were satisfied, especially with the increased, although not impressive, rotations. Pain did not disappear but decreased considerably, from visual analog scale 8-10 to 0-4.
Conversion into a RSA is a safe procedure in patients with a painful arthrodesis and grossly intact deltoid, providing better glenohumeral mobility (especially rotations), leading to improved patient satisfaction.
从历史角度来看，肩关节融合术是解决严重肩关节问题的一种方法，对于这些问题，人们认为不存在假体解决方案。随着反向肩关节置换术（RSA）的引入，该技术在盂肱关节处本质上是稳定的，那么在三角肌在肩关节融合术中未被破坏的情况下，将疼痛的肩关节融合术转换为RSA似乎是合理的。
4例患者（2男2女；年龄46 - 66岁），存在长期（5 - 11年）的肩关节融合术，因肩部疼痛（主要在肩胛骨周围）前来我院就诊，要求获得更大的活动度。总体而言，肩关节融合于外展60°至80°、前屈20°至40°以及内旋40°至50°。所有患者均拒绝采用截骨术治疗疼痛。术前肌电图显示三角肌至少后部或中部有活动，或两者均有。他们接受了将肩关节融合术翻修为反向假体的手术。讨论了所有并发症，尤其是不稳定性。手术通过先前的三角肌胸大肌切口瘢痕进行。3例患者的截骨术位于原关节线外侧，实现了一定程度的外侧移位。
随访时间为22至60个月。Constant - Murley评分从15 - 21分提高到30 - 60分。未发生脱位。所有患者均感到满意，尤其是对增加的旋转活动度（尽管增幅不大）感到满意。疼痛并未消失，但从视觉模拟评分8 - 10分大幅降至0 - 4分。
对于疼痛性肩关节融合且三角肌大体完整的患者，转换为RSA是一种安全的手术方法，可提供更好的盂肱关节活动度（尤其是旋转活动度），提高患者满意度。
