Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2018 May;27(5):801-807. doi: 10.1016/j.jse.2017.11.010. Epub 2018 Mar 13.
The influence of primary humeral stem fixation method (cemented or press fit) on intraoperative or postoperative outcomes in the setting of revision shoulder arthroplasty is unknown.
A retrospective analysis of a prospectively collected cohort of revision shoulder arthroplasty patients from a single tertiary center was performed. Demographic variables, intraoperative data, and 90-day complication rates were compared between cemented and press-fit primary stem fixation cohorts. Follow-up radiographs were graded and compared using a modified Gruen system for humeral lucencies.
Eighty-six primary shoulder replacements (34 hemiarthroplasties, 39 anatomic total shoulder arthroplasties, 13 reverse total shoulder arthroplasties) underwent revision arthroplasty with humeral stem removal between 2004 and 2017. Forty-five patients had cemented primary humeral fixation and 41 had press-fit fixation. The cemented cohort was older than the cementless cohort (66.6 vs. 61.4 years; P = .03) but otherwise demonstrated no difference in gender, body mass index, type of primary prosthesis (hemi, total, or reverse), or time between primary and revision operations. The cemented and cementless cohorts showed similar rates of humeral osteotomy (28.9% vs. 29.3%; P = .97), operative time (133.5 vs. 121.3 minutes; P = .16), and 90-day complication rates (13.3% vs. 9.8%; P = .61). Cemented vs. press-fit primary stems also had similar rates of humeral lucencies seen on follow-up radiographs after revision (77.1% vs. 60.6%; P = .14).
Humeral stem fixation with or without cement during primary shoulder arthroplasty demonstrated similar operative time, need for intraoperative humeral osteotomy, and postoperative complication rates in the setting of revision arthroplasty.
在肩关节翻修术中，肱骨干初次固定方式（骨水泥固定或压配固定）对术中或术后结果的影响尚不清楚。
对单中心前瞻性收集的肩关节翻修术患者队列进行回顾性分析。比较骨水泥固定和压配固定的肱骨干初次固定组之间的人口统计学变量、术中数据和 90 天并发症发生率。使用改良的 Gruen 系统对肱骨透亮区进行分级和比较随访的 X 线片。
2004 年至 2017 年期间，86 例初次肩关节置换（34 例半肩关节置换、39 例全肩关节置换、13 例反式全肩关节置换）行翻修术并取出肱骨干。45 例患者行肱骨干初次骨水泥固定，41 例行压配固定。骨水泥组比非骨水泥组年龄更大（66.6 岁比 61.4 岁；P = .03），但在性别、体重指数、初次假体类型（半肩、全肩或反肩）或初次手术与翻修手术之间的时间方面无差异。骨水泥组和非骨水泥组的肱骨截骨率（28.9%比 29.3%；P = .97）、手术时间（133.5 分钟比 121.3 分钟；P = .16）和 90 天并发症发生率（13.3%比 9.8%；P = .61）相似。翻修后随访 X 线片显示，骨水泥固定与非骨水泥固定的肱骨干初次固定的肱骨透亮区发生率也相似（77.1%比 60.6%；P = .14）。
初次肩关节置换时，肱骨干采用骨水泥固定或不固定的方式，在肩关节翻修术中具有相似的手术时间、需要术中行肱骨截骨和术后并发症发生率。
