Streit Jonathan J, Shishani Yousef, Greene Meridith E, Nebergall Audrey K, Wanner John Paul, Bragdon Charles R, Malchau Henrik, Gobezie Reuben
Orthopedics. 2015 Oct;38(10):e891-7. doi: 10.3928/01477447-20151002-56.
Aseptic glenoid component loosening is a common cause of total shoulder arthroplasty (TSA) failure, but early detection is difficult because pain often appears late and radiolucent lines are of uncertain significance. This study sought to answer the following questions: (1) What types of glenoid component motion may be observed during the first 3 years following implantation?; (2) Is the appearance of radiolucent lines around the glenoid component a reliable indicator of component motion?; and (3) Are clinical outcomes correlated with early glenoid component motion within the first 3 years after TSA? Eleven patients (mean age, 60.6 years) underwent TSA using a cemented, all-polyethylene glenoid component with tantalum bead implantation. Clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score, visual analog scale [VAS] pain score, and range of motion) were compared pre- and postoperatively, and radiolucencies were graded according to the criteria of Lazarus et al. Patients were evaluated using radiostereometric analysis at 6 months and 1, 2, and 3 years postoperatively to measure component micromotion in translation and rotation. At a mean follow-up of 50.2 months, mean ASES score had improved from 30.3 to 81.3 (P<.001), mean VAS pain score had improved from 8 to 1 (P<.001), active forward flexion had improved from 109° to 155° (P=.001), active external rotation had improved from 28° to 54° (P=.003), and internal rotation had improved from the level of the sacrum to L3 (P=.002). Radiolucencies were detected around none of the components at 1 year, 6 components at 2 years, and 5 components at 3 years, and these radiolucencies were mostly found around components that experienced high levels of rotational motion.
无菌性关节盂假体松动是全肩关节置换术（TSA）失败的常见原因，但早期检测困难，因为疼痛通常出现较晚，且透亮线的意义不明确。本研究旨在回答以下问题：（1）在植入后的前3年中可观察到哪些类型的关节盂假体运动？；（2）关节盂假体周围透亮线的出现是否是假体运动的可靠指标？；以及（3）临床结果与TSA后前3年内早期关节盂假体运动是否相关？11例患者（平均年龄60.6岁）接受了使用骨水泥固定的全聚乙烯关节盂假体并植入钽珠的TSA。比较术前和术后的临床结果（美国肩肘外科医师学会[ASES]评分、视觉模拟量表[VAS]疼痛评分和活动范围），并根据Lazarus等人的标准对透亮线进行分级。术后6个月以及1、2和3年使用放射立体测量分析对患者进行评估，以测量假体在平移和旋转方面的微动。平均随访50.2个月时，平均ASES评分从30.3提高到81.3（P<0.001），平均VAS疼痛评分从8提高到1（P<0.001），主动前屈从109°提高到155°（P=0.001），主动外旋从28°提高到54°（P=0.003），内旋从骶骨水平提高到L3水平（P=0.002）。1年时所有假体周围均未检测到透亮线；2年时6个假体周围检测到透亮线；3年时5个假体周围检测到透亮线，这些透亮线大多出现在旋转运动水平较高的假体周围。
