反式全肩关节置换术的长期疗效：一项既往研究的随访

Long-Term Outcomes of Reverse Total Shoulder Arthroplasty: A Follow-up of a Previous Study.

作者信息

Bacle Guillaume, Nové-Josserand Laurent, Garaud Pascal, Walch Gilles

机构信息

1Service d'Orthopédie et Traumatologie 1, Hôpital Trousseau, CHRU de Tours, Tours, France 2Hôpital Privé Jean Mermoz Ramsay-GDS, Centre Orthopédique Santy, Lyon, France.

出版信息

J Bone Joint Surg Am. 2017 Mar 15;99(6):454-461. doi: 10.2106/JBJS.16.00223.

DOI:10.2106/JBJS.16.00223

PMID:28291177

Abstract

BACKGROUND

Despite the increasing numbers of reverse total shoulder arthroplasty (RTSA) procedures, the long-term results have been rarely reported. We previously reported early outcomes of a cohort of patients treated with a Grammont-style RTSA. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic survival and complications.

METHODS

Clinical outcome assessment was based on the absolute and relative Constant scores and the active range of motion. Radiographic evaluations of scapular notching, tuberosity osteolysis, and periprosthetic radiolucent lines were done as well. Complications and revisions were compiled, and a Kaplan-Meier survival analysis was performed.

RESULTS

The original report included the outcomes for 186 patients (191 RTSAs) who had been followed for a mean of 40 months. In the present study, in which the mean duration of follow-up was 150 months, follow-up clinical evaluations were available for 84 patients (87 prostheses) and radiographic assessments were available for 64 patients (67 prostheses). Seventy-seven patients (79 prostheses) had died before the 10-year follow-up, and 17 patients (17 prostheses) had been lost to follow-up. The mean absolute and relative Constant scores (and standard deviations) were 55 ± 16 points and 86 ± 26 points, respectively, with both having decreased significantly compared with the scores at the medium-term follow-up evaluation (at a minimum of 2 years) (p < 0.001 and p = 0.025, respectively). Forty-nine shoulders (73%) exhibited scapular notching. Forty-seven complications (29%) were recorded, with 10 cases (10%) occurring after 2 years. Sixteen (12%) of the original patients underwent revision surgery. The 10-year overall prosthetic survival rate using revision as the end point was 93%.

CONCLUSIONS

Despite a high arthroplasty survival rate and good long-term clinical results, RTSA outcomes showed deterioration when compared with medium-term results. The cause of this decrease is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

尽管反向全肩关节置换术（RTSA）的手术数量不断增加，但长期结果却鲜有报道。我们之前报告过一组接受Grammont式RTSA治疗患者的早期结果。本研究的目的是评估至少10年后的结果，并记录假体生存率和并发症情况。

方法

临床结果评估基于绝对和相对Constant评分以及活动范围。还对肩胛切迹、结节骨溶解和假体周围透亮线进行了影像学评估。汇总并发症和翻修情况，并进行Kaplan-Meier生存分析。

结果

最初的报告纳入了186例患者（191例RTSA）的结果，这些患者平均随访了40个月。在本研究中，平均随访时间为150个月，84例患者（87个假体）有随访临床评估结果，64例患者（67个假体）有影像学评估结果。77例患者（79个假体）在10年随访前死亡，17例患者（17个假体）失访。绝对和相对Constant评分的平均值（及标准差）分别为55±16分和86±26分，与中期随访评估（至少2年）时的评分相比均显著降低（分别为p<0.001和p = 0.025）。49个肩关节（73%）出现肩胛切迹。记录到47例并发症（29%），其中10例（10%）发生在2年后。16例（12%）原患者接受了翻修手术。以翻修为终点的10年总体假体生存率为93%。