Nicholson Gregory P, Cvetanovich Gregory L, Rao Allison J, O'Donnell Patrick
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2017 Oct;26(10):1844-1853. doi: 10.1016/j.jse.2017.03.016. Epub 2017 May 5.
Total shoulder arthroplasty (TSA) in cases with posterior wear can be addressed by eccentric reaming of the anterior glenoid or by augmenting the posterior glenoid with bone grafting or augmented glenoid implants. We report the results of TSA with posterior glenoid bone grafting (PGBG) with humeral head autograft in patients with shoulder osteoarthritis and severe posterior glenoid wear.
A retrospective review of cases from 2004 to 2014 revealed 34 patients. Preoperative and postoperative radiographs were evaluated for glenoid version and humeral head subluxation as well as component loosening. Patient-reported outcomes were compared preoperatively and postoperatively. Complications and reoperations were also evaluated.
Of the 34 patients, 28 (82.4%) were available at a minimum of 2 years' follow-up. PGBG corrected glenoid retroversion from -28° ± 4° preoperatively to -4° ± 2° (P < .001). Humeral head subluxation also improved after PGBG with respect to the scapular axis and to the midglenoid face (P < .001). Radiographic analysis revealed all PGBGs had incorporated. Radiographically, 3 patients (10.7%) had a total of 5 broken or displaced screws. In addition, 3 patients (10.7%) had a broken metal marker in the center peg of the glenoid component. No patients required component revision surgery by final follow-up. Only 1 reoperation occurred for capsular release. Patients showed significant improvements in all patient-reported outcomes.
Patients undergoing primary TSA with humeral head autograft PGBG showed significant improvements in glenoid version, humeral head subluxation, patient-reported outcomes, and range of motion at an average of 4 years' follow-up. There was a low revision rate and a high rate of graft incorporation.
对于存在后方磨损的全肩关节置换术（TSA），可通过对前方关节盂进行偏心扩孔或采用植骨或增强型关节盂植入物来增强后方关节盂。我们报告了采用后方关节盂植骨（PGBG）联合肱骨头自体移植治疗肩关节骨关节炎且伴有严重后方关节盂磨损患者的TSA结果。
对2004年至2014年的病例进行回顾性分析，共纳入34例患者。对术前和术后的X线片进行评估，以观察关节盂形态、肱骨头半脱位情况以及假体松动情况。比较术前和术后患者报告的结果。同时评估并发症和再次手术情况。
34例患者中，28例（82.4%）获得了至少2年的随访。PGBG将关节盂后倾从术前的-28°±4°矫正至-4°±2°（P <.001）。PGBG术后肱骨头相对于肩胛轴和关节盂中央面的半脱位情况也得到改善（P <.001）。影像学分析显示所有PGBG均已融合。影像学检查发现，3例患者（10.7%）共有5枚螺钉断裂或移位。此外，3例患者（10.7%）的关节盂假体中央固定钉处有金属标记物断裂。至末次随访时，无患者需要进行假体翻修手术。仅1例因关节囊松解进行了再次手术。患者报告的所有结果均有显著改善。
接受原发性TSA联合肱骨头自体移植PGBG的患者，在平均4年的随访中，关节盂形态、肱骨头半脱位、患者报告的结果以及活动范围均有显著改善。翻修率低，植骨融合率高。
