Wey Aaron, Dunn John C, Kusnezov Nicholas, Waterman Brian R, Kilcoyne Kelly G
1 William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, TX, USA.
2 Rush University Medical Center, Chicago, IL, USA.
J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017718398. doi: 10.1177/2309499017718398.
In conjunction with reverse total shoulder arthroplasty (RSA), latissimus dorsi and teres major (LD-TM) transfer has been advocated in the setting of combined loss of elevation and external rotation. The purpose of this systematic review is to summarize the clinical outcomes following RSA with LD-TM transfer.
A search of PubMed, EMBASE, CINAHL, Medline, and Cochrane databases was performed between January 1, 1990 and March 1, 2016 and included articles related to outcomes following RSA with LD-TM transfer. Primary outcomes of interest were constant score, shoulder range of motion, and patient satisfaction. Secondary outcomes of interest included subjective shoulder value, simple shoulder test, activities of daily living requiring external rotation, and visual analog pain score. Additional outcomes evaluated included complications and reoperations. Frequency-weighted values of outcome data were utilized.
Five level IV studies involving 98 shoulders met the inclusion criteria. The mean age of the cohort was 69.1 ± 5.19 years (range 47-85). RSA with LD-TM transfer was performed for rotator cuff arthropathy (94%) or proximal humerus fracture (6%). The average follow-up was 44.5 ± 10.38 months (range 12-105 months). The constant score improved from 28 to 65 ( p < 0.0005). Active external rotation improved from -7.4° to 22.9° ( p < 0.0005). There was a 22.4% overall complication rate, including dislocation (5.1%), infection (5.1%), and transient nerve palsy (3.4%).
Patients undergoing RSA with LD-TM transfer in the setting of loss of external rotation demonstrate reliable clinical improvements in shoulder function with complication rates which are comparable to RSA alone.
在进行反式全肩关节置换术（RSA）时，对于合并有上举和外旋功能丧失的情况，提倡采用背阔肌和大圆肌（LD-TM）转移术。本系统评价的目的是总结RSA联合LD-TM转移术后的临床疗效。
检索了1990年1月1日至2016年3月1日期间的PubMed、EMBASE、CINAHL、Medline和Cochrane数据库，纳入了与RSA联合LD-TM转移术后疗效相关的文章。主要关注的结局指标为Constant评分、肩关节活动范围和患者满意度。次要关注的结局指标包括主观肩关节评分、简单肩关节测试、需要外旋的日常生活活动能力以及视觉模拟疼痛评分。还评估了其他结局指标，包括并发症和再次手术情况。采用结局数据的频率加权值。
五项IV级研究共纳入98例肩关节，符合纳入标准。队列的平均年龄为69.1±5.19岁（范围47-85岁）。RSA联合LD-TM转移术用于治疗肩袖关节病（94%）或肱骨近端骨折（6%）。平均随访时间为44.5±10.38个月（范围12-105个月）。Constant评分从28分提高到65分（p<0.0005）。主动外旋角度从-7.4°提高到22.9°（p<0.0005）。总体并发症发生率为22.4%，包括脱位（5.1%）、感染（5.1%）和短暂性神经麻痹（3.4%）。
在存在外旋功能丧失的情况下接受RSA联合LD-TM转移术的患者，肩关节功能有可靠的临床改善，并发症发生率与单纯RSA相当。
