Department of Orthopaedic Surgery, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Orthopaedic Surgery, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA.
J Shoulder Elbow Surg. 2019 Jan;28(1):9-14. doi: 10.1016/j.jse.2018.06.031. Epub 2018 Sep 14.
This retrospective review evaluated 25 patients with 29 shoulders treated with arthroplasty for humeral head avascular necrosis (HHAVN) between 2004 and 2015. We hypothesized that regardless of implant, radiographic stage, or etiology, patients would appreciate significant improvement in pain, range of motion, and shoulder functionality after surgical intervention.
Data were obtained by record review on all patients meeting inclusion criteria. Outcomes were evaluated using Simple Shoulder Test, Modified Constant Score, University of California Los Angeles Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The data were assessed by all patients and subcategories (treatment, avascular necrosis stage, and underlying cause).
At a mean follow-up of 3.9 years (range, 1-8.5 years), all patients who underwent operative intervention for HHAVN showed statistically significant improvement in functionality measurements (P < .01). Patients who underwent total shoulder arthroplasty (TSA) noted higher median outcome scores and greater improvement in all scoring methods compared with their hemiarthroplasty counterparts. The high-stage disease shoulders showed similar trends over low-stage counterparts. The shoulders in the trauma causal group had the highest scores in 3 of 4 outcome measures and favorable change in all scoring methods. These differences were not statistically significant (P > .05). No revision arthroplasties were required. Minor complications (suture abscess and intraoperative calcar fracture requiring cabling) occurred in 2 TSA patients.
Our outcomes demonstrate that in the short- to midterm follow-up, TSA or hemiarthroplasty is a safe and equally effective treatment for patients diagnosed with HHAVN regardless of etiology and radiographic staging.
本回顾性研究评估了 2004 年至 2015 年间 25 例 29 肩肱骨头缺血性坏死（HHAVN）患者行关节置换术的治疗效果。我们假设，无论植入物、影像学分期或病因如何，患者在接受手术干预后，疼痛、活动范围和肩部功能都会显著改善。
通过对符合纳入标准的所有患者的病历记录进行回顾，获取数据。使用简易肩部测试（Simple Shoulder Test）、改良 Constant 评分（Modified Constant Score）、加利福尼亚大学洛杉矶分校（UCLA）肩部评分量表（University of California Los Angeles Shoulder Rating Scale）和美国肩肘外科医生协会（American Shoulder and Elbow Surgeons）肩部评估标准表单（Standardized Shoulder Assessment Form）评估患者的预后。所有患者和亚组（治疗方法、缺血性坏死分期和潜在病因）都对结果进行了评估。
平均随访 3.9 年（1-8.5 年），所有接受 HHAVN 手术治疗的患者在功能测量方面均有统计学显著改善（P < .01）。与半肩关节置换术相比，行全肩关节置换术（total shoulder arthroplasty，TSA）的患者其中位数评分更高，所有评分方法的改善程度更大。高分期疾病的肩部与低分期疾病的肩部相比，也有相似的趋势。创伤性病因组的肩部在 4 项预后指标中的 3 项得分最高，所有评分方法均有明显改善。但这些差异无统计学意义（P > .05）。无翻修关节置换术。2 例 TSA 患者发生轻微并发症（缝线脓肿和术中骨嵴骨折需要缆线固定）。
我们的研究结果表明，在短期至中期随访中，TSA 或半肩关节置换术是一种安全且同样有效的治疗方法，适用于各种病因和影像学分期的 HHAVN 患者。
