McLendon P B, Cox J L, Frankle M A
Shoulder and Elbow Service, Florida Orthopaedic Institute, 33637, 13020 North Telecom Parkway, Tampa, FL, USA.
Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA.
Orthopade. 2017 Dec;46(12):1022-1027. doi: 10.1007/s00132-017-3498-z.
Proximal humeral bone loss in shoulder arthroplasty is a complex problem with a heterogeneous presentation. Different etiologies may contribute to varying degrees of severity in bone loss that dictate different treatment approaches.
The purpose of this is article is to describe our technique for treatment of proximal humeral bone loss with proximal humeral allograft prosthetic composites (APC) and identify factors that may predict when larger allografts may be necessary.
Ninety-nine patients were identified that had undergone reverse total shoulder arthroplasty with use of a proximal humeral allograft. Thirty-nine of these had large allografts that involved a significant portion of the diaphysis. Preoperative characteristics were examined to identify factors that may be associated with use of a larger diaphyseal-incorporating allograft.
Well-fixed humeral stems could be treated with short metaphyseal allografts in 55 of 65 (85%) cases. Loose stems required longer diaphyseal-incorporating allografts in 28 of 31 (90%) cases, and these were commonly associated with periprosthetic fractures (n = 10), failed prior APC (n = 6), and infection (n = 5). Noncemented stems required diaphyseal grafts in 75% of cases, compared to cemented stems which required larger grafts in 34% of cases.
Proximal humeral bone loss in the setting of revision shoulder arthroplasty can be successfully managed with a reverse total shoulder and proximal humeral allograft. Larger allografts are frequently required for loose humeral stems, and noncemented stems appear more likely to require larger allografts than cemented stems.
肩关节置换术中肱骨近端骨丢失是一个复杂的问题，表现各异。不同病因可能导致不同程度的骨丢失，进而决定不同的治疗方法。
本文旨在描述我们使用肱骨近端同种异体骨假体复合物（APC）治疗肱骨近端骨丢失的技术，并确定可能预测何时需要更大尺寸同种异体骨的因素。
确定99例接受使用肱骨近端同种异体骨的翻修全肩关节置换术的患者。其中39例患者使用了涉及骨干大部分的大尺寸同种异体骨。检查术前特征，以确定可能与使用更大尺寸包含骨干的同种异体骨相关的因素。
65例中有55例（85%）肱骨柄固定良好的病例可用短干骺端同种异体骨治疗。31例中有28例（90%）松动的肱骨柄需要更长的包含骨干的同种异体骨，这些情况通常与假体周围骨折（n = 10）、先前APC失败（n = 6）和感染（n = 5）相关。非骨水泥型肱骨柄75%的病例需要骨干移植，相比之下，骨水泥型肱骨柄34%的病例需要更大的移植骨。
翻修肩关节置换术中的肱骨近端骨丢失可以通过翻修全肩关节置换术和肱骨近端同种异体骨成功处理。松动的肱骨柄通常需要更大尺寸的同种异体骨，并且非骨水泥型肱骨柄似乎比骨水泥型肱骨柄更有可能需要更大尺寸的同种异体骨。
