Samuelsen Brian T, Wagner Eric R, Houdek Matthew T, Elhassan Bassem T, Sánchez-Sotelo Joaquín, Cofield Robert, Sperling John W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2017 Jan;26(1):e13-e17. doi: 10.1016/j.jse.2016.05.026. Epub 2016 Aug 10.
Reverse total shoulder arthroplasty (RTSA) has classically been reserved for patients older than 65 years with rotator cuff arthropathy, pseudoparalysis, and severe pain. This investigation assessed outcomes in a consecutive series of patients aged 65 and younger undergoing primary RTSA.
There were 63 patients (67 shoulders; 40 women, 27 men) with a mean age of 60 years (range, 50-65 years). Indications were cuff tear arthropathy (CTA) in 51, severe glenohumeral arthritis in 15, and osteonecrosis in 1. The primary end point was revision-free implant survival. Pain scale, motion, strength, and radiographic outcomes were also studied.
At a mean follow-up of 3 years (range, 2-8 years), the 2-year and 5-year revision-free survival was 99% and 91%, and reoperation-free survival was 97% and 90%, respectively. Complications occurred in 9%. Smoking increased the risk for revision, reoperation, and complications (P < .03). Patients experienced improvements in pain (P < .0001), active abduction (57.5° vs. 132.4°, P < .0001), and active external rotation (20.1° vs. 39.4°, P < .001). At the most recent follow-up, 90% patients were satisfied with their result, and 85% felt they were better or much better than before surgery. There was an 18% incidence notching, 3% incidence of dislocation, and no loosening.
At both 2 and 5 years, RTSA is a reliable operation in patients aged younger than 65 years. Patients gain significant improvements in pain level, range of motion, and strength, without a large number of early failures. Long-term follow-up is needed to understand late component mechanical problems and loosening.
传统上，反向全肩关节置换术（RTSA）仅适用于年龄超过65岁、患有肩袖关节病、假性麻痹和严重疼痛的患者。本研究评估了连续一系列65岁及以下接受初次RTSA患者的手术效果。
共有63例患者（67个肩关节；40名女性，27名男性），平均年龄60岁（范围50 - 65岁）。手术指征包括51例肩袖撕裂关节病（CTA）、15例严重的盂肱关节炎和1例骨坏死。主要终点是无翻修的植入物生存率。还研究了疼痛量表、活动度、力量和影像学结果。
平均随访3年（范围2 - 8年），2年和5年无翻修生存率分别为99%和91%，无再次手术生存率分别为97%和90%。并发症发生率为9%。吸烟增加了翻修、再次手术和并发症的风险（P < 0.03）。患者的疼痛（P < 0.0001）、主动外展（57.5°对132.4°，P < 0.0001）和主动外旋（20.1°对39.4°，P < 0.001）均有改善。在最近一次随访时，90%的患者对结果满意，85%的患者感觉比手术前更好或好多了。有18%的发生率出现骨切迹，3%的发生率出现脱位，无松动情况。
在2年和5年时，RTSA对于65岁以下患者是一种可靠的手术。患者在疼痛程度、活动范围和力量方面有显著改善，且早期失败情况较少。需要长期随访以了解后期假体的机械问题和松动情况。
