Triplet Jacob J, Everding Nathan G, Levy Jonathan C, Formaini Nathan T, O'Donnell Kevin P, Moor Molly A, Virraroel Leonardo D
Orthopedics. 2015 Oct;38(10):e904-10. doi: 10.3928/01477447-20151002-58.
Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) are routinely performed in patients older than 80 years. Often unaware of the differences between the 2 procedures, patients may expect similar outcomes from these procedures. This article reports the outcomes of primary TSA and RSA in patients older than 80 years, with attention directed toward differences in outcomes between the procedures. The authors evaluated a consecutive series of patients who were at least 80 years old and were treated with primary shoulder arthroplasty and had a minimum follow-up of 2 years. Of these patients, 18 underwent primary TSA for osteoarthritis and 33 underwent primary RSA for rotator cuff tear arthropathy. Pain scores, function scores, and range of motion were evaluated preoperatively and at final follow-up. Perioperative and postoperative complications, transfusion rates, length of stay, and subjective satisfaction with the outcome were reported. In these patients, TSA and RSA were similarly effective in improving pain scores, functional scores, and range of motion measurements. Patients who had TSA reported significantly greater satisfaction with surgery and had superior American Shoulder and Elbow Society total and function scores, forward elevation, and external rotation, but similar net improvement from preoperative levels. Although no significant differences were shown in complications, length of stay, or requirement for transfusion, patients treated with RSA had higher rates of transfusion and postoperative complications. Both procedures were similarly effective treatments for patients older than 80 years and showed similar improvements in pain, function, and motion. Patients undergoing RSA were less likely to have good to excellent results, with higher complication and transfusion rates.
解剖型全肩关节置换术（TSA）和反式全肩关节置换术（RSA）通常用于80岁以上的患者。患者往往不清楚这两种手术的区别，可能期望它们能带来相似的效果。本文报告了80岁以上患者初次TSA和RSA的手术效果，重点关注两种手术效果的差异。作者评估了一系列连续的患者，这些患者年龄至少80岁，接受了初次肩关节置换术，且至少随访2年。在这些患者中，18例因骨关节炎接受了初次TSA，33例因肩袖撕裂性关节病接受了初次RSA。术前和末次随访时评估疼痛评分、功能评分和活动范围。报告围手术期和术后并发症、输血率、住院时间以及对手术效果的主观满意度。在这些患者中，TSA和RSA在改善疼痛评分、功能评分和活动范围测量方面同样有效。接受TSA的患者对手术的满意度明显更高，美国肩肘协会的总分和功能评分、前屈和外旋功能也更优，但与术前水平相比净改善相似。虽然在并发症、住院时间或输血需求方面未显示出显著差异，但接受RSA治疗的患者输血率和术后并发症发生率更高。两种手术对80岁以上的患者同样有效，在疼痛、功能和活动方面均有相似改善。接受RSA的患者获得良好至优秀手术效果的可能性较小，并发症和输血率更高。
