Henry Patrick, Razmjou Helen, Dwyer Tim, Slade Shantz Jesse A, Holtby Richard
Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
BMC Musculoskelet Disord. 2015 Oct 5;16:280. doi: 10.1186/s12891-015-0741-9.
Arthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. The purpose of this study was twofold: 1) to examine the impact of arthroscopic debridement with or without subacromial decompression on clinical outcomes in patients with severe glenohumeral osteoarthritis (OA), and 2) to explore the differences in post-debridement outcomes between patients who eventually progressed to arthroplasty vs. those who did not. The role of an active worker's compensation claim was examined.
Prospectively collected data of patients who were not good candidates for shoulder arthroplasty and had subsequently undergone arthroscopic shoulder debridement were used for analysis. Disability was measured using the relative Constant-Murley score (CMS), the American Shoulder and Elbow Surgeon's (ASES) assessment form, pain free range of motion (ROM), and strength.
Fifty-six patients were included in the final analysis. Eighteen (32 %) patients underwent arthroplasty surgery (arthroplasty group) over a period of 11 years. The arthroplasty group was comparable with the non-arthroplasty group prior to debridement but was more disabled at post-debridement surgery follow-up, functioning at less than 50 % of normal based on ASES, relative CMS, and active painfree ROM. In the multivariable analysis, the post-debridement relative CMS was affected by having a compensation claim and having a future arthroplasty.
Arthroscopic debridement improved clinical outcome in 68 % of patients suffering from advanced OA of glenohumeral joint. Having less than 50 % of normal score in ASES, relative CMS and painfree ROM post- debridement within a period of two years may be an indication for future arthroplasty. Role of worker's compensation claims should not be underestimated.
对于年轻的活跃人群，当由于推荐的活动限制、并发症风险和/或早期磨损以及翻修需求而关节置换术可能不是一个实际选择时，关节镜下盂肱关节清创术用于症状控制已显示出有希望的短期结果。本研究的目的有两个：1）检查关节镜下清创术联合或不联合肩峰下减压对严重盂肱关节骨关节炎（OA）患者临床结局的影响，以及2）探讨最终进展为关节置换术的患者与未进展为关节置换术的患者清创术后结局的差异。研究了积极的工伤赔偿申请的作用。
前瞻性收集的不适合肩关节置换术且随后接受关节镜下肩关节清创术的患者数据用于分析。使用相对Constant-Murley评分（CMS）、美国肩肘外科医生（ASES）评估表、无痛活动范围（ROM）和力量来测量残疾情况。
56例患者纳入最终分析。18例（32%）患者在11年期间接受了关节置换手术（关节置换组）。关节置换组在清创术前与非关节置换组相当，但在清创术后随访时残疾程度更高，根据ASES、相对CMS和主动无痛ROM，其功能低于正常水平的50%。在多变量分析中，清创术后的相对CMS受工伤赔偿申请和未来关节置换术的影响。
关节镜下清创术改善了68%的盂肱关节晚期OA患者的临床结局。清创术后两年内ASES、相对CMS和无痛ROM得分低于正常水平的50%可能是未来关节置换术的指征。工伤赔偿申请的作用不应被低估。
