Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota, Vermillion, SD, USA.
University of South Dakota, Vermillion, SD, USA.
J Shoulder Elbow Surg. 2018 Dec;27(12):2120-2128. doi: 10.1016/j.jse.2018.08.030.
To date, no studies have been published that have assessed the optimal position of sling immobilization after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis.
Thirty-six patients undergoing anatomic total shoulder arthroplasty for osteoarthritis were randomized to a neutral rotation sling versus an internal rotation sling. The primary outcomes assessed included the Disabilities of the Arm, Shoulder and Hand score; Western Ontario Osteoarthritis of the Shoulder score; Single Assessment Numeric Evaluation score; visual analog scale (VAS) scores for pain and satisfaction; compliance ratings; and radiographic and range-of-motion measurements. Primary outcomes were assessed at baseline and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year.
All patient-determined outcome scores for both groups revealed statistically significant improvements (P < .0001) from enrollment to final follow-up. There were statistically significant advantages to the neutral rotation sling group compared with the internal rotation sling group when we evaluated the improvements in (1) active external rotation (42° vs 25°, P = .03), (2) passive external rotation (44° vs 26°, P = .02), (3) passive horizontal adduction (7.7 cm vs 3.7 cm, P = .05), and (4) pain relief with passive adduction (VAS score, 6.2 cm vs 3.5 cm; P = .002). There was a trend toward greater improvements in the neutral rotation sling group when we measured (1) active horizontal adduction (8.3 cm vs 2.9 cm, P = .06) and (2) active internal rotation behind the back (18 cm vs 11.1 cm, P = .09). At 2 weeks, the neutral rotation sling group had significantly less night pain than the internal rotation sling group (mean VAS score, 18 mm vs 34 mm; P = .047).
Neutral rotation sling use after anatomic total shoulder arthroplasty resulted in statistically significant improvements in external rotation and adduction, as well as decreased night pain, compared with an internal rotation sling.
迄今为止，尚无研究评估全肩关节置换术后盂肱关节骨关节炎吊带固定的最佳位置。
36 例全肩关节置换术治疗骨关节炎患者随机分为中立旋转吊带组和内旋吊带组。主要评估结果包括上肢残疾量表（DASH）评分、西部安大略省肩关节炎评分（WOSI）、单项评估数值评定（SANE）评分、疼痛和满意度视觉模拟量表（VAS）评分、依从性评分、影像学和活动范围测量。主要结果在基线和术后 2 周、6 周、3 个月、6 个月和 1 年时进行评估。
两组患者的所有患者确定的结果评分均显示从入组到最终随访均有统计学显著改善（P<0.0001）。与内旋吊带组相比，中立旋转吊带组在以下方面具有统计学优势：（1）主动外旋（42° vs 25°，P=0.03）；（2）被动外旋（44° vs 26°，P=0.02）；（3）被动水平内收（7.7cm vs 3.7cm，P=0.05）；（4）被动内收时疼痛缓解（VAS 评分，6.2cm vs 3.5cm；P=0.002）。当我们测量（1）主动水平内收（8.3cm vs 2.9cm，P=0.06）和（2）主动背后内旋（18cm vs 11.1cm，P=0.09）时，中立旋转吊带组有更大的改善趋势。在 2 周时，中立旋转吊带组的夜间疼痛明显少于内旋吊带组（平均 VAS 评分，18mm vs 34mm；P=0.047）。
与内旋吊带相比，全肩关节置换术后使用中立旋转吊带可显著改善外旋和内收，并减少夜间疼痛。
