Sellers Thomas R, Abdelfattah Adham, Frankle Mark A
Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA.
South Texas Bone and Joint Institute, San Antonio, TX, USA.
Curr Rev Musculoskelet Med. 2018 Mar;11(1):131-140. doi: 10.1007/s12178-018-9467-2.
The purpose of this review is to discuss the indications for reverse shoulder arthroplasty (RSA) in the treatment of massive rotator cuff tear (MCT), review the reported outcomes in the literature, and outline our approach and surgical technique for treating these patients.
While RSA remains a successful and well-accepted treatment for cuff tear arthropathy (CTA), management of MCT in the absence of arthritis is controversial. In this particular setting, patients best suited for RSA are elderly, lower-demand individuals with chronic, irreparable MCT, and pseudoparalysis. Age < 60, better pre-operative function and upper extremity neurologic dysfunction are potential risk factors for poor outcome with RSA in this population. Long-term follow-up studies of RSA for CTA and MCT show good functional outcomes and implant survival > 90% at 10 years. Treatment of MCT must be individualized for each patient. When patient selection is optimized, RSA is a reliable means of relieving pain and improving function with excellent success. Further investigation is necessary to better define its indications and assess the role of alternative, joint-salvaging procedures.
本综述旨在探讨反式肩关节置换术（RSA）治疗巨大肩袖撕裂（MCT）的适应证，回顾文献报道的治疗结果，并概述我们治疗这些患者的方法和手术技术。
虽然RSA仍然是治疗肩袖撕裂性关节病（CTA）的一种成功且被广泛接受的治疗方法，但在无关节炎情况下MCT的治疗仍存在争议。在这种特殊情况下，最适合RSA的患者是患有慢性、不可修复MCT且存在假性麻痹的老年、需求较低的个体。年龄<60岁、术前功能较好以及上肢神经功能障碍是该人群中RSA治疗效果不佳的潜在危险因素。对CTA和MCT进行RSA的长期随访研究显示，10年时功能结果良好，植入物生存率>90%。MCT的治疗必须针对每个患者进行个体化。当患者选择优化时，RSA是缓解疼痛和改善功能的可靠方法，成功率很高。需要进一步研究以更好地确定其适应证，并评估替代的保关节手术的作用。
