Friedrich M, Cucchi D, Walter S, Gravius S, Wirtz D C, Schmolders J
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland.
Oper Orthop Traumatol. 2019 Apr;31(2):115-126. doi: 10.1007/s00064-019-0588-6. Epub 2019 Feb 6.
Reconstruction of proximal humeral bone defects in the setting of shoulder revision arthroplasty by implantation of a modular humeral component.
Severe segmental humeral bone defects in revision total shoulder arthroplasty, after tumor resection, trauma, pathological fractures, post-infectious or after failed osteosynthesis.
Acute or chronic local infections, large diaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months).
Removal of the implant using an extended deltopectoral approach. Periarticular arthrolysis with preservation of neurovascular structures. Resection of the meta-diaphyseal bone and reconstruction of the humeral length with the help of different extension sleeves and a modular humeral component. Soft tissue management is crucial, especially with reverse shoulder arthroplasty.
Three weeks postoperatively immobilization in a shoulder sling, active assisted movement therapy by gradual pain-adapted increase of movement, muscle coordination, and strength.
The results of 11 consecutive patients treated with a modular humeral component due to a failed shoulder arthroplasty between 2008 and 2016 were evaluated retrospectively. Mean length of reconstruction was 100 mm. Due to recurrent dislocations one patient required revision and conversion to a reverse component. No cases of aseptic loosening or periprosthetic infection were observed.
通过植入模块化肱骨组件重建肩关节翻修术中的近端肱骨骨缺损。
翻修全肩关节置换术、肿瘤切除术后、创伤后、病理性骨折后、感染后或骨固定失败后的严重节段性肱骨骨缺损。
急性或慢性局部感染、骨干大段骨缺损妨碍假体充分固定、预期寿命极短（<3个月）。
采用扩大的胸大肌三角肌入路取出植入物。保留神经血管结构进行关节周围松解。切除干骺端骨，并借助不同的延长套管和模块化肱骨组件重建肱骨长度。软组织处理至关重要，尤其是在进行反式肩关节置换术时。
术后三周用肩吊带固定，通过逐渐根据疼痛调整增加活动度、肌肉协调性和力量进行主动辅助运动治疗。
回顾性评估了2008年至2016年间因肩关节置换失败而接受模块化肱骨组件治疗的11例连续患者的结果。平均重建长度为100毫米。由于复发性脱位，1例患者需要翻修并转换为反式组件。未观察到无菌性松动或假体周围感染病例。
