Otto Randall J, Clark Rachel E, Frankle Mark A
Shoulder and Elbow Service, Premier Care Orthopedics & Sports Medicine, St. Louis, MO, USA.
Clinical Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
J Shoulder Elbow Surg. 2017 May;26(5):792-797. doi: 10.1016/j.jse.2016.09.051. Epub 2016 Dec 26.
This study reports the outcomes of reverse shoulder arthroplasty (RSA) in patients younger than 55 years with midterm to long-term follow-up.
Sixty-seven patients (average age, 47.9 years; range, 21-54 years) were identified who underwent RSA with an average 62.3 months of follow-up (24-144 months). There were 35 patients (group 1) who had a failed arthroplasty and 32 patients (group 2) who underwent primary RSA. Clinical outcomes included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, and range of motion. Complications included radiographic failures (fracture, dislocation, notching, loosening), infections, and nerve palsies.
Group 1 showed significant improvements in flexion and abduction but not in external or internal rotation. Group 2 showed significant improvements in flexion, abduction, and internal rotation but not in external rotation. Both groups showed significant improvements in ASES and SST scores. In group 1, ASES score improved from 24.4 to 40.8 (P = .003), and SST score improved from 1.3 to 3.2 (P = .043). In group 2, ASES score improved from 28.1 to 58.6 (P < .001), and SST score improved from 1.3 to 4.5 (P = .004). The total complication rate was 22.4%. The total reoperation rate was 13.4%, and the revision rate was 8.9%. The implant retention rate was 91% at last follow-up.
RSA in patients younger than 55 years provides significant clinical improvements with high implant retention at up to 12 years. Patients undergoing revision RSA begin with worse function than those undergoing primary RSA, but they can expect similar degrees of improvement. Complications were higher but reoperation rates were lower in the revision group. No mechanical failures occurred in the primary group, with infection the cause of all revisions.
本研究报告了年龄小于55岁患者行反式肩关节置换术（RSA）的中期至长期随访结果。
确定67例患者（平均年龄47.9岁；范围21 - 54岁），他们接受了RSA，平均随访62.3个月（24 - 144个月）。其中35例患者（第1组）关节置换失败，32例患者（第2组）接受初次RSA。临床结果包括美国肩肘外科医师（ASES）评分、简易肩关节测试（SST）评分和活动范围。并发症包括影像学失败（骨折、脱位、切迹、松动）、感染和神经麻痹。
第1组在屈曲和外展方面有显著改善，但在外旋或内旋方面无改善。第2组在屈曲、外展和内旋方面有显著改善，但在外旋方面无改善。两组的ASES和SST评分均有显著改善。在第1组中，ASES评分从24.4提高到40.8（P = 0.003），SST评分从1.3提高到3.2（P = 0.043）。在第2组中，ASES评分从28.1提高到58.6（P < 0.001），SST评分从1.3提高到4.5（P = 0.004）。总并发症发生率为22.4%。总再次手术率为13.4%，翻修率为8.9%。最后一次随访时植入物保留率为91%。
年龄小于55岁患者行RSA可带来显著的临床改善，植入物保留率高，长达12年。接受翻修RSA的患者初始功能比接受初次RSA的患者差，但他们有望获得相似程度的改善。翻修组并发症较高，但再次手术率较低。初次手术组未发生机械性失败，所有翻修均因感染所致。
