Luedke Colten, Kissenberth Michael J, Tolan Stefan J, Hawkins Richard J, Tokish John M
Steadman Hawkins Clinic of the Carolinas, Greenville Health Systems, Greenville, South Carolina.
Mayo Clinic, Phoenix, Arizona.
JBJS Rev. 2018 Apr;6(4):e7. doi: 10.2106/JBJS.RVW.17.00112.
Total shoulder arthroplasty remains an effective procedure for shoulder pain relief. Despite the negative effect of abnormal glenoid morphology and specifically retroverted and posteriorly subluxated glenoids, there is no consensus for management of B2 glenoids in total shoulder arthroplasty. The purpose of this study was to compare the outcomes and complication rates for B2 glenoid techniques so as to provide a baseline understanding of the current state of treatment of this pathology.
A systematic review evaluating outcomes of total shoulder arthroplasty with biconcave glenoids using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology included searches up to December 31, 2015, of PubMed, Embase, MEDLINE, Cochrane Reviews, and Google Scholar. Nine articles met inclusion and exclusion criteria.
In this study, 239 total shoulder arthroplasties with B2 glenoids with a mean follow-up of 55.5 months (range, 24 to 91 months) were included. The mean patient age was 63.3 years (range, 55.8 to 68.7 years). Asymmetric reaming was performed in 127 glenoids, posterior bone-grafting was included in 53 glenoids, and 34 received an augmented glenoid component to correct glenoid retroversion and bone loss. Overall, the mean Constant and Neer scores improved from preoperative measures. Fifty-eight percent of patients had no loosening, and 42% had some loosening, although not all of these patients were symptomatic. Despite variation in outcome measures hindering treatment approach comparison, the posteriorly augmented glenoid was generally reported to provide better outcomes with few complications. Although posterior glenoid bone-grafting results in acceptable outcomes, it also represents the highest rate of complications. The revision rate was 15.6% for asymmetric reaming, 9.5% for posterior glenoid bone-grafting, and 0% for posteriorly augmented glenoids.
Surgical treatment of the B2 glenoid remains a challenge to the shoulder surgeon, with worse outcomes and higher complication rates. Longer follow-up, consistent outcome measures, and result stratification based on glenoid type may allow for direct comparison in the future.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
全肩关节置换术仍是缓解肩部疼痛的有效方法。尽管关节盂形态异常，特别是关节盂后倾和后脱位会产生负面影响，但在全肩关节置换术中对于B2型关节盂的处理尚无共识。本研究的目的是比较B2型关节盂技术的疗效和并发症发生率，以便对该病理状况的当前治疗现状有一个基线了解。
采用PRISMA（系统评价和Meta分析的首选报告项目）方法对使用双凹关节盂的全肩关节置换术的疗效进行系统评价，检索截至2015年12月31日的PubMed、Embase、MEDLINE、Cochrane综述和谷歌学术。9篇文章符合纳入和排除标准。
本研究纳入了239例采用B2型关节盂的全肩关节置换术，平均随访55.5个月（范围24至91个月）。患者平均年龄为63.3岁（范围55.8至68.7岁）。127个关节盂采用不对称扩孔，53个关节盂采用后方植骨，34个关节盂接受增强型关节盂假体以纠正关节盂后倾和骨质流失。总体而言，Constant和Neer平均评分较术前有所改善。58%的患者没有松动，42%的患者有一些松动，尽管并非所有这些患者都有症状。尽管结果测量的差异阻碍了治疗方法的比较，但一般报道后方增强型关节盂能提供更好的疗效且并发症较少。尽管后方关节盂植骨能取得可接受的疗效，但它也是并发症发生率最高的方法。不对称扩孔的翻修率为15.6%，后方关节盂植骨的翻修率为9.5%，后方增强型关节盂的翻修率为0%。
B2型关节盂的手术治疗对肩部外科医生来说仍然是一个挑战，疗效较差且并发症发生率较高。更长时间的随访、一致的结果测量以及基于关节盂类型的结果分层可能有助于未来进行直接比较。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
