Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
Clin Orthop Surg. 2019 Mar;11(1):112-119. doi: 10.4055/cios.2019.11.1.112. Epub 2019 Feb 18.
Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population.
We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014.
In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; = 0.009), and varus humeral neck-shaft angle ( = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores.
Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.
尽管反肩置换术（RSA）的应用日益增多，但它与相对频繁的并发症和不确定的临床结果有关。我们研究了影响韩国人群 RSA 临床结果的放射学因素。
我们评估了 2008 年至 2014 年间在两个中心接受 RSA 的 179 例连续患者的体格检查、影像学检查、疼痛和满意度的视觉模拟评分以及几个功能评分。
在 146 例纳入的 RSA 中，三角肌延长（平均 23.5 ± 9.1 毫米； = 0.039）可改善疼痛和前屈。内侧化可使外旋减少（平均 16.8 ± 6.0 毫米， = 0.025），而内旋与肱骨头后倾无相关性。肩胛切迹（n = 44，30%）随肩胛下窝过度覆盖（平均 2.94 ± 3.0 毫米； = 0.001）、假体肩胛颈角度（平均 104° ± 10.3°； = 0.001）、肩胛颈长度（平均 9.8 ± 2.54 毫米； = 0.012）、下基底部倾斜角度（平均 105.5° ± 9.2°； = 0.009）和肱骨颈干角（ = 0.046）的增加而显著减少，但不影响活动范围和疼痛、满意度和功能评分。在最终随访时，内侧化与疼痛和满意度的改善有关，而肩胛下窝过度覆盖与功能评分有关。
在韩国人群中，为了获得更好的结果，应选择适当的三角肌延长（平均 2.3 厘米）和肩胛下窝过度覆盖（平均 2.9 毫米），而旋转中心应根据患者的个体特征进行个体化。
