The San Antonio Orthopaedic Group and Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A..
Cape Shoulder Institute, Cape Town, South Africa.
Arthroscopy. 2017 Nov;33(11):1920-1925. doi: 10.1016/j.arthro.2017.04.005. Epub 2017 Jun 28.
To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up.
We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision.
Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 to 2 (median difference [Δ], 4 [95% CI, 3-6]; P < .0001), representing pain relief similar to total shoulder arthroplasty in young patients. Improvements in the median ASES score (from 47 to 76; Δ, 28 [95% CI, 17-40]; P < .0001), active forward elevation (from 110° to 140°; Δ, 20° [95% CI, 10°-35°]; P < .0001), and active external rotation (from 0° to 20°; Δ, 10° [95% CI, 5°-20°]; P < .0001) were noted. The mean age of revised shoulders (60 years [95% CI, 54-66 years]) was higher than that of surviving shoulders (53 years [95% CI, 50-57 years], P = .005). The preoperative ASES score of revised shoulders (34 [95% CI, 27-42]) was lower than that of surviving shoulders (47 [95% CI, 43-51], P = .006). No complications were noted.
AGR with dermal allograft is a safe option for joint preservation in selected patients, provides pain relief, and has an acceptable rate of revision to prosthetic arthroplasty at short-term to midterm follow-up. Increased age and lower preoperative ASES score were risk factors for failure of AGR.
Level IV, therapeutic case series.
研究关节镜下肩胛盂表面置换术（AGR）治疗严重肩关节炎的短期至中期随访结果。
我们对 2005 年至 2013 年期间行 AGR 治疗（至少 2 年随访或直至翻修）的连续患者进行了多中心回顾性研究，并排除失访和先前研究中包含的患者。AGR 的适应证为年轻、高需求患者的原发性肩关节炎伴严重、无明显骨丢失。评估指标包括翻修、疼痛和美国肩肘外科医生（ASES）评分以及活动范围。采用确切的逻辑回归分析评估术前翻修的危险因素。
43 例患者平均随访 60 个月，接受 AGR 治疗。平均 45 个月后，行假体关节置换翻修的比例为 23%（95%置信区间[CI]，12%-39%）。视觉模拟评分（0-10）从中位数 7 分降至 2 分（中位数差值[Δ]，4 [95% CI，3-6]；P <.0001），代表与年轻患者行全肩关节置换术的疼痛缓解程度相似。ASES 评分（从 47 分提高至 76 分；Δ，28 [95% CI，17-40]；P <.0001）、主动前屈上举（从 110°提高至 140°；Δ，20° [95% CI，10°-35°]；P <.0001）和主动外旋（从 0°提高至 20°；Δ，10° [95% CI，5°-20°]；P <.0001）也有显著改善。翻修组的平均年龄（60 岁[95% CI，54-66 岁]）高于存活组（53 岁[95% CI，50-57 岁]，P =.005）。翻修组术前 ASES 评分（34 [95% CI，27-42]）低于存活组（47 [95% CI，43-51]，P =.006）。未发生并发症。
对于特定患者，真皮同种异体移植物的 AGR 关节保留是一种安全的选择，可缓解疼痛，并具有可接受的短期至中期假体关节置换翻修率。年龄增加和术前 ASES 评分降低是 AGR 失败的危险因素。
IV 级，治疗性病例系列研究。
