Thangarajah Tanujan, Higgs Deborah, Bayley J I L, Lambert Simon M
Tanujan Thangarajah, Deborah Higgs, J I L Bayley, Simon M Lambert, the Shoulder and Elbow Service, the Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom.
World J Orthop. 2016 Jul 18;7(7):434-41. doi: 10.5312/wjo.v7.i7.434.
To report the results of fixed-fulcrum fully constrained reverse shoulder arthroplasty for the treatment of recurrent shoulder instability in patients with epilepsy.
A retrospective review was conducted at a single facility. Cases were identified using a computerized database and all clinic notes and operative reports were reviewed. All patients with epilepsy and recurrent shoulder instability were included for study. Between July 2003 and August 2011 five shoulders in five consecutive patients with epilepsy underwent fixed-fulcrum fully constrained reverse shoulder arthroplasty for recurrent anterior shoulder instability. The mean duration of epilepsy in the cohort was 21 years (range, 5-51) and all patients suffered from grand mal seizures.
Mean age at the time of surgery was 47 years (range, 32-64). The cohort consisted of four males and one female. Mean follow-up was 4.7 years (range, 4.3-5 years). There were no further episodes of instability, and no further stabilisation or revision procedures were performed. The mean Oxford shoulder instability score improved from 8 preoperatively (range, 5-15) to 30 postoperatively (range, 16-37) (P = 0.015) and the mean subjective shoulder value improved from 20 (range, 0-50) preoperatively to 60 (range, 50-70) postoperatively (P = 0.016). Mean active forward elevation improved from 71° preoperatively (range, 45°-130°) to 100° postoperatively (range, 80°-90°) and mean active external rotation improved from 15° preoperatively (range, 0°-30°) to 40° (20°-70°) postoperatively. No cases of scapular notching or loosening were noted.
Fixed-fulcrum fully constrained reverse shoulder arthroplasty should be considered for the treatment of recurrent shoulder instability in patients with epilepsy.
报告采用固定支点全约束反式肩关节置换术治疗癫痫患者复发性肩关节不稳的结果。
在单一机构进行回顾性研究。通过计算机数据库识别病例，并查阅所有临床记录和手术报告。纳入所有患有癫痫和复发性肩关节不稳的患者进行研究。2003年7月至2011年8月，连续5例癫痫患者的5个肩关节因复发性前肩关节不稳接受了固定支点全约束反式肩关节置换术。该队列中癫痫的平均病程为21年（范围5 - 51年），所有患者均患有大发作癫痫。
手术时的平均年龄为47岁（范围32 - 64岁）。该队列包括4名男性和1名女性。平均随访时间为4.7年（范围4.3 - 5年）。未再出现不稳发作，也未进行进一步的稳定或翻修手术。牛津肩关节不稳平均评分从术前的8分（范围5 - 15分）提高到术后的30分（范围16 - 37分）（P = 0.015），主观肩关节评分平均从术前的20分（范围0 - 50分）提高到术后的60分（范围50 - 70分）（P = 0.016）。平均主动前屈上举从术前的71°（范围45° - 130°）提高到术后的100°（范围80° - 90°），平均主动外旋从术前的15°（范围0° - 30°）提高到术后的40°（20° - 70°）。未发现肩胛切迹或松动病例。
对于癫痫患者复发性肩关节不稳的治疗，应考虑采用固定支点全约束反式肩关节置换术。
