Kadum Bakir, Wahlström Per, Khoschnau Shwan, Sjödén Göran, Sayed-Noor Arkan
Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden.
Department of Hand Surgery, Umeå University, Umeå, Sweden.
J Shoulder Elbow Surg. 2016 Oct;25(10):e285-94. doi: 10.1016/j.jse.2016.02.021. Epub 2016 Apr 12.
Restoration of shoulder geometry is desirable in total shoulder arthroplasty (TSA) and thought to influence the postoperative clinical outcome. We aimed to study the association of postoperative lateral humeral offset (LHO) changes and clinical outcome, as well as to investigate the ability of stemless anatomic TSA to restore shoulder geometry.
In patients with primary shoulder osteoarthritis who underwent stemless anatomic TSA, the preoperative and postoperative clinical outcome was measured. Shoulder geometry was measured on preoperative computed tomography for the osteoarthritic shoulder and contralateral healthy shoulder and on postoperative computed tomography for the operated shoulder.
Forty-four patients with a minimum follow-up of 12 months (range, 12-50 months) were available for the study. Postoperatively, the clinical outcome measures improved. The postoperative difference in LHO between the operated shoulder and contralateral healthy shoulder was 1.3 ± 4.6 mm and was correlated with scores on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire at 3 months (Pearson correlation = 0.36, P = .01) and visual analog scale for pain at rest (Pearson correlation = 0.30, P = .03) and with exertion (Pearson correlation = 0.34, P = .01) at 3 months. Lengthening of LHO was associated with worsening shoulder function at 3 months but not at 12 months. The postoperative shoulder geometric parameters were restored postoperatively to acceptable ranges.
The stemless anatomic TSA could restore shoulder geometry in an acceptable manner. At 3 months but not at 12 months, increased LHO had a negative effect on shoulder function and resulted in more shoulder pain at rest and with exertion but did not affect quality of life, health status, or range of motion.
全肩关节置换术（TSA）中恢复肩关节形态是理想的，并且认为会影响术后临床结果。我们旨在研究术后肱骨外侧偏移（LHO）变化与临床结果之间的关联，并调查无柄解剖型TSA恢复肩关节形态的能力。
对接受无柄解剖型TSA的原发性肩关节骨关节炎患者，测量术前和术后的临床结果。在术前对骨关节炎肩关节和对侧健康肩关节进行计算机断层扫描（CT）测量肩关节形态，术后对手术侧肩关节进行CT测量。
44例患者纳入研究，最短随访12个月（范围12 - 50个月）。术后，临床结果指标有所改善。手术侧肩关节与对侧健康肩关节术后LHO的差异为1.3±4.6 mm，与术后3个月时手臂、肩部和手部功能障碍问卷简版评分（Pearson相关系数 = 0.36，P = 0.01）、静息时疼痛视觉模拟量表评分（Pearson相关系数 = 0.30，P = 0.03）以及术后3个月时用力时的评分（Pearson相关系数 = 0.34，P = 0.01）相关。LHO延长与术后3个月时肩关节功能恶化相关，但与12个月时无关。术后肩关节几何参数恢复到可接受范围。
无柄解剖型TSA能够以可接受的方式恢复肩关节形态。在术后3个月而非12个月时，LHO增加对肩关节功能有负面影响，导致静息和用力时肩部疼痛更多，但不影响生活质量、健康状况或活动范围。
