Boyd A D, Thornhill T S
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Rheum Dis Clin North Am. 1988 Dec;14(3):591-611.
Shoulder dysfunction is unusual in osteoarthritis and usually responds to conservative treatment. The primary indication for surgery is pain unresponsive to medical management. The procedure of choice for degenerative changes in the glenohumeral joint is hemiarthroplasty or total shoulder replacement depending on the condition of the glenoid. Shoulder fusion is rarely necessary for osteoarthritis and is recommended for chronic infection, flail shoulder, and failed total shoulder replacement not amenable to revision. Joint resection is reserved for infected joints with massive bone loss. The results of shoulder arthroplasty are good to excellent in 86 to 94 per cent of all patients. The results of shoulder arthrodesis are less predictable, but are usually satisfactory in approximately 75 per cent of patients with 10-year follow-up. The treatment of AC and SC joint arthritis is conservative with rest, local heat, and medication. Pain unresponsive to this regimen is an indication for resection of the joint. Good results with this procedure directly correlate with pain relief on injection of the joint with local anesthetic.
在骨关节炎中，肩部功能障碍并不常见，通常对保守治疗有效。手术的主要指征是对药物治疗无反应的疼痛。根据关节盂的情况，对于盂肱关节退变改变，选择的手术方式是半关节置换术或全肩关节置换术。对于骨关节炎，很少需要进行肩关节融合术，该手术推荐用于慢性感染、连枷肩以及无法进行翻修的全肩关节置换失败病例。关节切除术适用于伴有大量骨质流失的感染关节。在所有患者中，86%至94%的肩关节置换术结果良好至极佳。肩关节融合术的结果较难预测，但在约75%接受10年随访的患者中通常令人满意。肩锁关节和胸锁关节关节炎的治疗采用保守方法，包括休息、局部热敷和药物治疗。对该治疗方案无反应的疼痛是关节切除的指征。该手术的良好效果与局部麻醉剂注射关节时疼痛缓解直接相关。
