Statz Joseph M, Wagner Eric R, Houdek Matthew T, Cofield Robert H, Sanchez-Sotelo Joaquin, Elhassan Bassem T, Sperling John W
Department of Orthopedic Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
J Shoulder Elbow Surg. 2016 Jul;25(7):e191-8. doi: 10.1016/j.jse.2015.12.008. Epub 2016 Feb 19.
Obesity is a risk factor for worse outcomes in anatomic shoulder arthroplasty. The purpose of this investigation was to determine outcomes of primary reverse shoulder arthroplasty (RSA) in patients with morbid obesity.
We reviewed all primary RSAs performed on morbidly obese (body mass index [BMI] ≥40 kg/m(2)) patients from 2005 to 2012 at our institution with at least 2 years of follow-up. The study included 41 patients (57% female), the mean BMI was 44 kg/m(2), and the mean age was 67.7 years.
The only intraoperative complication was an inferior glenoid fracture that remained stable after glenosphere implantation. At a mean follow-up of 3.2 years (range 2-7.36 years), 2 patients (5%) required revision surgery for infection (n = 1) and humeral loosening (n = 1). Survival was 98% at 2 years and 92% at 5 years. Additional postoperative complications included ulnar neuropathy (n = 1) and heterotopic ossification (n = 2). Pain relief was excellent, with 93% reporting moderate or severe pain preoperatively compared with 2% postoperatively (P < .001). Shoulder abduction improved from 49° to 142° and external rotation from 17° to 50° (P < .001). The average American Shoulder and Elbow Surgeons score was 71.1. At the most recent follow-up, no patients had glenoid lucency, 1 (2%) had humeral lucency, and 2 (5%) had inferior scapular notching. Laborers had higher risk for revision surgery (P = .01), and females had worse functional outcomes and shoulder motion (P < .02).
RSA is a successful procedure in morbidly obese patients (BMI ≥40 kg/m(2)). At intermediate follow-up, there is good implant survival with a reasonable complication rate and excellent pain relief.
肥胖是解剖型肩关节置换术预后较差的一个危险因素。本研究的目的是确定病态肥胖患者初次反式肩关节置换术（RSA）的预后。
我们回顾了2005年至2012年在本机构对病态肥胖（体重指数[BMI]≥40kg/m²）患者进行的所有初次RSA手术，且随访时间至少为2年。该研究纳入了41例患者（57%为女性），平均BMI为44kg/m²，平均年龄为67.7岁。
唯一的术中并发症是肩胛盂下方骨折，在植入球窝假体后保持稳定。平均随访3.2年（范围2 - 7.36年），2例患者（5%）因感染（n = 1）和肱骨松动（n = 1）需要翻修手术。2年生存率为98%，5年生存率为92%。其他术后并发症包括尺神经病变（n = 1）和异位骨化（n = 2）。疼痛缓解情况极佳，术前93%的患者报告有中度或重度疼痛，术后这一比例为2%（P <.001）。肩关节外展从49°改善至142°，外旋从17°改善至50°（P <.001）。美国肩肘外科医生平均评分为71.1分。在最近一次随访时，没有患者出现肩胛盂透亮，1例（2%）出现肱骨透亮，2例（5%）出现肩胛下角切迹。劳动者翻修手术风险较高（P = 0.01），女性功能预后和肩关节活动情况较差（P < 0.02）。
RSA对于病态肥胖患者（BMI≥40kg/m²）是一种成功的手术。在中期随访中，植入物生存率良好，并发症发生率合理，疼痛缓解效果极佳。
