Schnetzke Marc, Wittmann Thomas, Raiss Patric, Walch Gilles
BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
OCM Klinik München, Munich, Germany.
Arch Orthop Trauma Surg. 2019 Feb;139(2):149-154. doi: 10.1007/s00402-018-3039-1. Epub 2018 Sep 21.
The aim of the study was to evaluate the short-term clinical results of anatomic total shoulder arthroplasty with a short-stem prosthesis in primary osteoarthritis.
65 shoulders with a mean age of 70 years (range 47-85 years) were available for minimum follow-up of 24 months. Clinical outcome was determined by range of motion, Constant score (CS) age and sex-adjusted Constant score (CS%), and subjective shoulder value (SSV). The influence of six different factors (high bone adaptations, age > 65 years, female gender, dominant side, atrophy of the supraspinatus tendon ≥ grade 2, glenoid type B2/B3) on the clinical outcome was assessed.
At mean follow-up of 37 months (range 24-58 months), the CS improved from 36 ± 8 to 75 ± 12 (p < 0.001). The shoulder flexion (100° ± 21° to 159° ± 19°) as well as the external rotation (3° ± 11° to 43° ± 18°) improved significantly (p < 0.001). Three complications were noted (transient neuropraxia of the radial nerve, subjective instability, hematoma with superficial wound infection) leading to one revision surgery (wound debridement). No stem loosening was observed. High bone adaptation was present in 19 out of 65 shoulders (29%). The clinical outcome was not influenced by high bone adaptations (p ≥ 0.095). Age > 65 years (n = 44) and female gender (n = 38) were associated with worse clinical outcome (p ≤ 0.043).
In the short term, the clinical results of this anatomical short-stem shoulder prosthesis are encouraging. A low prevalence of high bone adaptations was found without any influence on the clinical outcome and stem loosening was not observed.
本研究的目的是评估采用短柄假体的解剖型全肩关节置换术治疗原发性骨关节炎的短期临床效果。
65例平均年龄70岁(范围47 - 85岁)的肩部患者接受了至少24个月的随访。临床结果通过活动范围、常数评分(CS)、年龄和性别调整后的常数评分(CS%)以及主观肩关节评分(SSV)来确定。评估了六个不同因素(高骨适应性、年龄>65岁、女性、优势侧、冈上肌腱萎缩≥2级、B2/B3型关节盂)对临床结果的影响。
平均随访37个月(范围24 - 58个月)时,CS从36±8提高到75±12(p<0.001)。肩关节前屈(从100°±21°到159°±19°)以及外旋(从3°±11°到43°±18°)均有显著改善(p<0.001)。记录到3例并发症(桡神经短暂性神经失用、主观不稳定、血肿伴浅表伤口感染),导致1例翻修手术(伤口清创)。未观察到柄松动。65例肩部中有19例(29%)存在高骨适应性。高骨适应性对临床结果无影响(p≥0.095)。年龄>65岁(n = 44)和女性(n = 38)与较差的临床结果相关(p≤0.043)。
短期内,这种解剖型短柄肩关节假体的临床效果令人鼓舞。高骨适应性的发生率较低,对临床结果无任何影响,且未观察到柄松动。