von Engelhardt Lars V, Manzke Michael, Breil-Wirth Andreas, Filler Timm J, Jerosch Joerg
Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany.
Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany.
World J Orthop. 2017 Oct 18;8(10):790-797. doi: 10.5312/wjo.v8.i10.790.
To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.
Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.
Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, . ( > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes ( > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.
TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.
评估采用TESS系统的无柄解剖型肩关节置换术的关节几何学及临床疗效。
纳入21例平均随访18个月的肩关节病例。在数字化X线片上，使用MediCAD软件评估术前旋转中心（CoR），并与假体的CoR进行比较。此外，还评估了CoR相对于肩胛盂、肩峰以及肱骨近端的术前和术后几何学。同时评估诸如透亮线等放射学变化。采用Constant和DASH评分评估临床疗效。
Constant和DASH评分均显著改善，分别从11%提高到75%，从70分降至30分，P均<0.01。在年龄、病因、骨水泥固定或金属背衬肩胛盂方面无显著差异（P>0.05）。术前和术后的肱骨偏移、外侧肱盂偏移、CoR高度、肩峰肱骨距离以及颈干角均无显著变化（P>0.05）。假体CoR与解剖中心的平均偏差为1.0±2.8 mm。3例出现内侧偏差超过3 mm。这些偏差分别为5.1、5.7和7.6 mm，是由肱骨颈截骨不准确所致。这3例患者的结局评分相对较差。
TESS关节置换术可实现解剖型关节重建，疗效良好。本研究中描述的异常情况提醒外科医生要准确进行肱骨颈截骨。
