不进行背阔肌转移的反肩关节置换术后外旋功能的恢复
Restoration of External Rotation Following Reverse Shoulder Arthroplasty without Latissimus Dorsi Transfer.
作者信息
Berglund Derek D, Rosas Samuel, Triplet Jacob J, Kurowicki Jennifer, Horn Brandon, Levy Jonathan C
机构信息
Holy Cross Orthopedic Institute, Fort Lauderdale, Florida.
Wake Forest Baptist Health, Winston-Salem, North Carolina.
出版信息
JB JS Open Access. 2018 Apr 19;3(2):e0054. doi: 10.2106/JBJS.OA.17.00054. eCollection 2018 Jun 28.
BACKGROUND
Latissimus dorsi transfers have been considered necessary to restore active external rotation following reverse shoulder arthroplasty (RSA). The purpose of this study was to assess the effectiveness of an RSA system that lateralizes the center of rotation in restoring active external rotation without a latissimus dorsi transfer in patients with a preoperative external rotation deficit (external rotation of <0°).
METHODS
We retrospectively reviewed the records of patients who had undergone RSA with a lateralized center of rotation without a latissimus dorsi transfer. All patients had had a preoperative external rotation deficit (active external rotation of <0°), and all were followed for a minimum of 2 years. Patients were stratified into 2 groups on the basis of the preoperative diagnosis: (1) those with a combined loss of active elevation and external rotation as a result of rotator cuff tear arthropathy (CLEER group) and (2) those with a combined loss of active elevation and external rotation as a result of other posttraumatic etiologies (non-CLEER group). The mean improvement of external rotation was analyzed. Subgroup analysis was performed on the basis of the Goutallier classification, glenosphere lateralization, and total prosthetic lateralization.
RESULTS
Thirty-three patients (24 in the CLEER group and 9 in the non-CLEER group) met the inclusion criteria. The average follow-up was 43.4 months (range, 24 to 77 months). External rotation improved significantly in both the CLEER group (from -21° preoperatively to 28° postoperatively; p < 0.001) and the non-CLEER group (from -19° preoperatively to 26° postoperatively; p = 0.001). Goutallier classification, glenosphere lateralization, and total prosthetic lateralization were not correlated with the degree of improvement of external rotation in either group (p > 0.05 for all).
CONCLUSIONS
RSA with a lateralized center of rotation can effectively restore external rotation without the use of a latissimus dorsi transfer in patients with a preoperative external rotation deficit as a result of rotator cuff arthropathy or other posttraumatic etiologies.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
背阔肌转移术被认为是在反肩关节置换术（RSA）后恢复主动外旋所必需的。本研究的目的是评估一种使旋转中心外移的RSA系统在术前存在外旋功能障碍（外旋<0°）的患者中，不进行背阔肌转移术时恢复主动外旋的有效性。
方法
我们回顾性分析了接受旋转中心外移且未进行背阔肌转移术的RSA患者的记录。所有患者术前均存在外旋功能障碍（主动外旋<0°），且均至少随访2年。根据术前诊断将患者分为两组：（1）因肩袖撕裂性关节病导致主动上举和外旋功能同时丧失的患者（CLEER组）；（2）因其他创伤后病因导致主动上举和外旋功能同时丧失的患者（非CLEER组）。分析外旋的平均改善情况。根据Goutallier分级、关节盂球窝外移程度和假体整体外移程度进行亚组分析。
结果
33例患者（CLEER组24例，非CLEER组9例）符合纳入标准。平均随访时间为43.4个月（范围24至77个月）。CLEER组（术前-21°，术后28°；p<0.001）和非CLEER组（术前-19°，术后26°；p = 0.001）的外旋均有显著改善。Goutallier分级、关节盂球窝外移程度和假体整体外移程度与两组中外旋的改善程度均无相关性（所有p>0.05）。
结论
对于因肩袖关节病或其他创伤后病因导致术前外旋功能障碍的患者，采用旋转中心外移的RSA可在不使用背阔肌转移术的情况下有效恢复外旋功能。
证据水平
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
Zotero 插件