Barlow Jonathan D, Abboud Joseph
Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Department of Orthopaedic Surgery, The Rothman Insitute, Philadelphia, PA, USA.
Int J Shoulder Surg. 2016 Jan-Mar;10(1):28-36. doi: 10.4103/0973-6042.174516.
Young patients with glenohumeral arthritis are an ongoing treatment challenge. They typically have high demands of their shoulders, require long-term durability due to their young age, and often have altered local anatomy, through their disease process (instability arthropathy, juvenile rheumatoid arthritis, etc.) or from previous surgery (capsulorraphy arthropathy, chondrolysis, etc.). Workup to evaluate underlying causes of early arthritis, and to exclude infectious causes are necessary. When nonoperative management fails, arthroscopic debridement, hemiarthroplasty (isolated, with glenoid reaming, or with biological interposition), and total shoulder arthroplasty are treatment options available to the treating surgeon. Debridement or hemiarthroplasty can provide pain relief for a subset of patients, but results have not been reproducible across the literature and have not been durable over time. Total shoulder arthroplasty provides the most reliable pain relief, but long-term glenoid loosening and wear continue to lead to high revision rates in this patient population.
患有盂肱关节炎的年轻患者一直是治疗上的挑战。他们通常对肩部功能有较高要求，由于年龄较轻，需要长期的耐用性，并且常常因疾病过程（不稳定关节病、幼年类风湿性关节炎等）或既往手术（关节囊缝合关节病、软骨溶解等）导致局部解剖结构改变。进行检查以评估早期关节炎的潜在病因并排除感染性病因是必要的。当非手术治疗失败时，关节镜下清创术、半关节成形术（单独进行、伴有肩胛盂扩孔或生物植入）以及全肩关节置换术是可供治疗外科医生选择的治疗方法。清创术或半关节成形术可为一部分患者缓解疼痛，但文献报道的结果并不一致，且随着时间推移效果并不持久。全肩关节置换术能提供最可靠的疼痛缓解，但长期来看，肩胛盂松动和磨损仍导致该患者群体的翻修率较高。
