Florida Orthopaedic Institute, Tampa, FL, USA.
Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
J Shoulder Elbow Surg. 2018 May;27(5):794-800. doi: 10.1016/j.jse.2017.10.035. Epub 2017 Dec 20.
This study evaluated the effect of cystic changes in the glenoid on postoperative outcomes and implant survival after total shoulder arthroplasty (TSA).
From 2004 to 2012, 75 patients underwent TSA for primary osteoarthritis with minimum 5-year follow-up. Preoperative 3-dimensional models based on computed tomography imaging were created for all patients. A qualitative evaluation of cystic osteoarthritis was performed through survey grading by 3 fellowship-trained shoulder surgeons. The extent of cyst formation in the glenoid (no cysts, small, medium, or large) was assigned for every patient. In addition, quantitative evaluation was performed on 3-dimensional glenoid models. Functional outcomes, radiographic findings, and the need for revision were compared between group 1 (large and medium cysts) and group 2 (small and no cysts).
Qualitative evaluation of cyst formation resulted in the following distribution: no cysts in 8 patients (11%), small cyst formation in 27 (36%), medium cysts in 19 (25%), and large cysts in 21 patients (28%; κ = 0.605). The difference in total cyst volume between group 1 and group 2 was significant (P = .004). The overall revision rate was 7% (5 of 75). All revised patients were in the groups with medium or large cysts. There were no statistical differences in American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment scores or presence of radiographic loosening among the study groups.
Qualitative computed tomography evaluation of cystic osteoarthritis correlates with quantitative analysis of cyst volume. Severe cyst formation portends a higher risk of failure at midterm follow-up. Cystic disease did not affect functional outcome or the presence of radiographic glenoid loosening.
本研究评估了肩盂囊性变对全肩关节置换术（TSA）后术后结果和植入物存活率的影响。
2004 年至 2012 年，75 例原发性骨关节炎患者接受了 TSA 治疗，随访时间至少为 5 年。对所有患者均进行基于计算机断层扫描成像的术前三维模型创建。通过 3 位 fellowship培训的肩部外科医生进行调查分级，对囊性骨关节炎进行定性评估。为每位患者分配了盂肱关节盂的囊性形成程度（无囊肿、小、中或大）。此外，还对三维肩盂模型进行了定量评估。比较了第 1 组（大、中囊肿）和第 2 组（小、无囊肿）之间的功能结果、影像学发现和翻修需求。
囊性形成的定性评估结果分布如下：无囊肿 8 例（11%），小囊肿形成 27 例（36%），中囊肿 19 例（25%），大囊肿 21 例（28%；κ=0.605）。第 1 组和第 2 组之间的总囊肿体积差异有统计学意义（P=0.004）。总的翻修率为 7%（5/75）。所有翻修患者均在中或大囊肿组。在研究组中，美国肩肘外科医生（ASES）标准肩部评估评分或影像学松动的存在没有统计学差异。
囊性骨关节炎的 CT 定性评估与囊肿体积的定量分析相关。严重的囊性形成预示着中期随访失败的风险较高。囊性疾病不会影响功能结果或影像学肩盂松动的存在。
