Gohlke F, Werner B
Klinik für Schulter- und Ellenbogenchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland.
Orthopade. 2017 Dec;46(12):1008-1014. doi: 10.1007/s00132-017-3484-5.
The treatment of bone defects in primary shoulder arthroplasty has evolved due to more detailed diagnostic tools, 3D planning and expanded indications for reverse shoulder arthroplasty. Glenoid bone defects combined with chronic posterior subluxation of the humeral head are gradually being treated by glenoid reconstruction and reverse implants even if the rotator cuff is still intact. The treatment of advanced bone loss due to glenoid loosening has been facilitated by bone augmentation using a cementless fixation as proposed by Norris. Precise pre-operative planning using reformatted computed tomography (CT) and dedicated instruments is recommended in primary and revision arthroplasty.
Revision rates and complications are high for revision surgery in extended glenoid and humeral bone loss. Functional results are limited in these cases, particularly after multiple operations and damage of the soft tissue envelope.
由于更详细的诊断工具、三维规划以及反向肩关节置换术适应证的扩大，初次肩关节置换术中骨缺损的治疗方法不断发展。即使肩袖仍然完整，对于合并肱骨头慢性后脱位的肩胛盂骨缺损，也逐渐采用肩胛盂重建和反向植入物进行治疗。诺里斯提出的使用非骨水泥固定进行骨增量，有助于治疗因肩胛盂松动导致的严重骨丢失。初次和翻修关节置换术中，建议使用重建计算机断层扫描（CT）和专用器械进行精确的术前规划。
对于存在广泛肩胛盂和肱骨骨丢失的翻修手术，翻修率和并发症较高。在这些病例中，功能结果有限，尤其是在多次手术和软组织包膜受损之后。
