Werner B S, Stehle J, Abdelkawi A, Plumhoff P, Hudek R, Gohlke F
Klinik für Schulter- und Ellenbogenchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany.
Orthopädisches Zentrum, Friedrichshafen, Germany.
Orthopade. 2017 Dec;46(12):1028-1033. doi: 10.1007/s00132-017-3483-6.
Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon.
The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors.
We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X‑rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion.
We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74-0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9 mm at more than 5 years' follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%.
Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.
非骨水泥型肩关节表面置换术是传统带柄解剖型假体的一种替代方案。盂肱关节侵蚀是半关节置换术中一种众所周知的并发症。然而，关于这种现象的影像学评估和预后因素的数据有限。
我们研究的目的是使用一种新的测量技术确定肩关节表面置换术后盂肱关节侵蚀的发展情况，并检测潜在的预后因素。
我们对38例接受肱骨头表面置换术的肩关节进行了回顾性分析，平均随访时间为65.4±43个月。临床和影像学评估遵循标准化方案，包括术前和术后的Constant评分、主动活动范围以及标准前后位X线片。由三名独立观察者对盂肱关节侵蚀情况进行测量。
我们发现观察者之间对盂肱关节侵蚀测量的可靠性良好（组内相关系数[ICC]为0.74 - 0.78）。所有病例均出现进行性盂肱关节侵蚀，在超过5年的随访中平均为5.5±3.9毫米。男性患者在最初5年内盂肱关节骨质流失增加（p < 0.04）。在最近一次随访时，Constant评分平均提高到55.4±23.6分。年龄较小与功能结果改善相关。因疼痛性盂肱关节侵蚀导致的翻修率为37%。
接受肱骨头表面置换术的患者可常规预期出现盂肱关节侵蚀。疼痛性盂肱关节侵蚀会导致功能结果恶化，并且在很大比例的病例中需要进行翻修手术。
