Department of Orthopaedic Surgery, Washington University in St. Louis Medical Center, St. Louis, MO, USA.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6S):S58-S64. doi: 10.1016/j.jse.2018.01.003. Epub 2018 Feb 28.
This study describes the short-term functional and radiographic outcomes after total shoulder arthroplasty (TSA) in shoulders with a B2 glenoid deformity addressed with corrective reaming.
We conducted a retrospective series of consecutive patients who underwent TSA with a Walch B2 glenoid quantified by computed tomography scan. All glenoid deformities were addressed using partially corrective glenoid reaming. Radiographic and functional outcome measures, including scores on the visual analog scale for pain, American Shoulder and Elbow Standardized Shoulder Assessment, and Simple Shoulder Test were collected.
Functional outcome scores were available for 59 of 92 eligible subjects (64%) at a mean of 50 months. The mean preoperative retroversion measured 18° (range, -1° to 36°), superior inclination was 8° (range, -11° to 27°), and posterior subluxation was 67% (range, 39%-91%). Mean visual analog scale improved from 7.4 to 1.4, the American Shoulder and Elbow Shoulder Standardized Assessment improved from 35.4 to 84.3, and the SST improved from 4.5 to 9.1. Radiographs were evaluated at a mean of 31 months: 38 had no glenoid radiolucent lines, 13 glenoids had grade 1, 2 had grade 2, and 5 had grade 3 lucencies. There was no difference in the rate of progression of glenoid radiolucencies between shoulders with a preoperative glenoid version of ≤20° (27.8%) compared with glenoids with >20° of retroversion (22.7%, P = .670). No shoulders were revised due to glenoid loosening or instability.
TSA with partial corrective glenoid reaming in selected shoulders with a B2 glenoid deformity resulted in excellent functional and radiographic outcomes at short-term follow-up, with a low risk of revision surgery.
本研究描述了通过计算机断层扫描(CT)扫描定量评估的 B2 型肩盂畸形患者,在接受全肩关节置换术(TSA)后短期的功能和影像学结果。
我们对连续接受 TSA 治疗的 B2 型肩盂畸形患者进行了回顾性研究,所有肩盂畸形均采用部分矫正型盂肱关节盂成形术进行处理。收集影像学和功能评估结果,包括疼痛视觉模拟评分、美国肩肘外科协会(ASES)评分和简单肩部测试(SST)评分。
59 例符合条件的患者(64%)中有 50 个月的平均功能评分,其中 18°(范围:-1°至 36°)的平均术前后旋角、8°(范围:-11°至 27°)的上倾斜角和 67%(范围:39%至 91%)的后下脱位。视觉模拟评分从 7.4 分改善至 1.4 分,ASES 评分从 35.4 分改善至 84.3 分,SST 评分从 4.5 分改善至 9.1 分。在平均 31 个月时进行 X 线评估:38 例无肩盂透亮线,13 例肩盂出现 1 级透亮线,2 例肩盂出现 2 级透亮线,5 例肩盂出现 3 级透亮线。术前肩盂后倾角度≤20°(27.8%)与>20°(22.7%)的肩盂,其肩盂透亮线进展率无差异(P = .670)。没有因肩盂松动或不稳定而翻修的病例。
对于选择的 B2 型肩盂畸形患者,采用部分矫正型盂肱关节盂成形术行 TSA 治疗,在短期随访中可获得良好的功能和影像学结果,翻修手术风险较低。