Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
J Shoulder Elbow Surg. 2019 Jan;28(1):e1-e9. doi: 10.1016/j.jse.2018.06.026. Epub 2018 Sep 7.
Revision shoulder arthroplasty in the setting of glenoid bone loss poses substantial surgical challenges. This study's purpose was to compare radiographic and clinical results of patients requiring structural iliac crest bone autograft (ICBA) for severe bone loss versus patients with less severe bone loss treated with nonstructural bone allograft (NSBA) in the setting of revision reverse total shoulder arthroplasty (RSA).
A retrospective cohort of 30 patients (70% of the 43 patients who met the inclusion criteria) undergoing revision RSA with ICBA (n = 15) or NSBA (n = 15) between 2007 and 2015 were analyzed at a minimum 2-year follow-up. Radiographic assessment included bone graft integration, bone graft resorption, glenosphere tilt, glenosphere version, and the presence of scapular notching. Clinical assessment included active range of motion, Penn Shoulder Score, Veterans RAND 12-item health survey, and need for revision surgery.
No radiographic difference was found between the ICBA and NSBA groups with regard to implant position, graft integration, scapular notching, implant shift, or failure of fixation (P > .05). Of 15 patients with ICBA, 14 (93%) had at least partial integration of the bone graft. Some degree of resorption of the bone graft was noted in 6 of 15 patients (40%). There was no significant difference in postoperative active range of motion, Penn Shoulder Score, or Veterans RAND 12-item health survey score (P > .05 for all comparisons). One patient in the ICBA group underwent revision surgery for glenoid baseplate failure.
Revision RSA with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up. Patients requiring structural ICBA were not at increased risk of component failure, radiographic or clinical complications, or inferior clinical outcomes.
在肩胛盂骨缺损的情况下，进行肩部关节翻修术存在着巨大的手术挑战。本研究的目的是比较结构性髂嵴骨自体移植物（ICBA）用于严重骨缺损患者和非结构性骨同种异体移植物（NSBA）用于轻度骨缺损患者的翻修反式全肩关节置换术（RSA）的影像学和临床结果。
回顾性分析了 2007 年至 2015 年间接受 ICBA（n=15）或 NSBA（n=15）翻修 RSA 的 30 名患者（符合纳入标准的 43 名患者中的 70%），这些患者至少随访了 2 年。影像学评估包括骨移植物融合、骨移植物吸收、肱骨头倾斜度、肱骨头倾斜角和肩胛盂切迹。临床评估包括主动活动范围、Penn 肩部评分、退伍军人 RAND 12 项健康调查和翻修手术的需要。
在植入物位置、移植物融合、肩胛盂切迹、植入物移位或固定失败方面，ICBA 组与 NSBA 组之间没有发现影像学差异（P>.05）。在 15 名接受 ICBA 的患者中，14 名（93%）的骨移植物至少有部分融合。15 名患者中有 6 名（40%）出现了一定程度的骨移植物吸收。术后主动活动范围、Penn 肩部评分或退伍军人 RAND 12 项健康调查评分无显著差异（所有比较 P>.05）。ICBA 组中有 1 名患者因肩胛盂基底部失败而行翻修手术。
在短期随访中，RSA 加肩胛盂植骨术可获得良好的临床和影像学结果。需要结构性 ICBA 的患者并未增加组件失效、影像学或临床并发症的风险，也未出现较差的临床结果。
