Werthel Jean-David, Schoch Bradley, Sperling John W, Cofield Robert, Elhassan Bassem T
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2016 May;25(5):791-6. doi: 10.1016/j.jse.2015.09.032. Epub 2015 Dec 15.
Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis.
Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings.
Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation.
Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made.
脊髓灰质炎感染常常会导致诸如关节炎、骨质疏松、肌肉无力、骨骼变形以及关节慢性不稳定等骨科并发症。本研究的目的是评估针对脊髓灰质炎后遗症患者行肩关节置换术的疗效及相关并发症。
1976年至2013年间，7例（平均年龄70岁）脊髓灰质炎后遗症患者接受了肩关节置换术。1例患者接受了反式肩关节置换术，2例接受了半肩关节置换术，4例接受了全肩关节置换术。平均随访时间为87个月。疗效指标包括疼痛、活动范围以及术后改良的Neer评分。
肩关节置换术后，总体疼痛评分从5分（满分5分）降至1.6分。在最近一次随访时，6例患者的肩部无疼痛或仅有轻微疼痛，6例患者将手术结果评为“明显改善”或“改善”。平均肩关节前屈上举从72°提高到129°，外旋从11°提高到56°。术后平均前屈上举力量从3.9降至3.4，外旋力量从3.9降至3.3，但差异无统计学意义。4例患者的肩部出现了影像学不稳定伴肌肉失衡的表现，包括上半脱位、前脱位或两者皆有，但均无症状。无一例患者需要翻修或再次手术。
肩关节置换术能显著缓解脊髓灰质炎后遗症患者的疼痛并改善其活动度。肌肉无力可能是术后不稳定的原因，因此必须仔细挑选上肢肌肉状况良好的患者。
