Ivaldo Nicola, Mangano Tony, Caione Giovanni, Rossoni Mario, Ligas Angelo
Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy.
Casa di Cura Villa Igea, Acqui Terme, Italy.
Musculoskelet Surg. 2016 Dec;100(Suppl 1):13-18. doi: 10.1007/s12306-016-0404-5. Epub 2016 Nov 30.
Glenoid bone defect and excessive medialization could represent challenging issues during reverse shoulder arthroplasty, especially in the setting of revision surgery. Although a solution is offered by the Boileau's BIO-RSA technique in primary cases, only autologous iliac crest bone graft and homologous graft from bone banks are available for revision surgeries, with known disadvantages and risk of graft resorption and implant failure.
We describe in this work a new technique based on a customized porous tantalum device to be used in salvage situations, aimed at lateralization of the glenoid component of a reverse shoulder arthroplasty. Between 2014 and 2015, five patients received a customized tantalum-augmented RSA at our institution. The augments we applied are actually on the market for acetabular bone loss management: these were opportunely prepared and fixed to the metal back of the glenoid component before implantation.
In the five cases treated, no major or minor complications have been recorded to date. Despite the short follow-up, all the implants are still in situ. All of the patients referred complete subjective satisfaction and return to their daylife activities without pain within 4 months after surgery.
The customized tantalum-augmented RSA technique represents in our experience a useful and safe solution in managing glenoid bone loss and medialization. Adaptability to virtually every device in the market should be regarded as important point of strength of this technique.
肩胛盂骨缺损和过度内移在反肩关节置换术中可能是具有挑战性的问题，尤其是在翻修手术中。虽然在初次手术中，布瓦洛的生物型反肩关节置换术（BIO-RSA）提供了一种解决方案，但在翻修手术中，只有自体髂嵴骨移植和来自骨库的同种异体移植可用，这些方法存在已知的缺点以及移植骨吸收和植入失败的风险。
我们在这项研究中描述了一种基于定制多孔钽装置的新技术，用于挽救性手术，旨在使反肩关节置换术的肩胛盂部件向外移位。2014年至2015年期间，我们机构有5例患者接受了定制钽增强反肩关节置换术。我们应用的增强装置实际上是用于髋臼骨缺损处理的市售产品：在植入前对其进行适当准备并固定在肩胛盂部件的金属背板上。
在接受治疗的5例患者中，迄今为止尚未记录到任何重大或轻微并发症。尽管随访时间较短，但所有植入物仍在位。所有患者均表示主观上完全满意，术后4个月内无痛地恢复了日常活动。
根据我们的经验，定制钽增强反肩关节置换术是处理肩胛盂骨缺损和内移的一种有用且安全的解决方案。该技术对市场上几乎所有器械的适应性应被视为其重要优势。
