Department of Orthopaedic Surgery, College of Medicine, Ulsan University, Ulsan, Republic of Korea.
Department of Orthopaedic Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2019 Dec;28(12):2334-2342. doi: 10.1016/j.jse.2019.04.035. Epub 2019 Jul 9.
Rapidly destructive arthropathy (RDA) of the shoulder is rare. Consequently, there are very few studies that have reported the characteristic findings of this disease. This study aimed to analyze the clinical, radiographic, and histologic features of patients with RDA of the shoulder.
In total, 9 cases (8 patients) were enrolled in this study. All patients were elderly women, with a mean age of 72.7 years (range, 57-78 years). The mean duration of symptoms was 4.1 months (range, 1.2-5.9 months). Reverse total shoulder arthroplasty and total shoulder arthroplasty were performed in 5 cases with massive rotator cuff tears and 4 without them, respectively.
The mean duration of radiologically evident joint destruction after negative results on radiography was 3.1 months (range, 1.0-5.9 months). On plain radiography, humeral head flattening and collapse that appeared like cut grass were observed (100%). Relatively good preservation of the glenoid with a normal joint space was observed in 7 cases, whereas glenoid erosion was observed in 2 (22.2%). T1-weighted magnetic resonance imaging showed a subchondral fracture (100%) of low signal intensity with associated bone marrow edema. Histologically, chronic inflammation of the synovium and osteocytes in the lacunae, as well as callus formation, were observed along the subchondral fracture.
Flattening and collapse of the humeral head within an average of 4 months of symptom onset are characteristic of RDA of the shoulder. Bone marrow edema, joint effusion, and subchondral fracture on magnetic resonance imaging and fracture fragments and callus formation on histopathologic analysis were observed. Glenoid erosion was observed in 2 cases with arthrosis progression.
肩急进性破坏性关节炎（RDA）较为罕见。因此，仅有少数研究报道了该病的特征性表现。本研究旨在分析肩 RDA 患者的临床、影像学和组织学特征。
共纳入 9 例（8 例患者）患者。所有患者均为老年女性，平均年龄为 72.7 岁（57-78 岁）。症状持续时间的平均时间为 4.1 个月（1.2-5.9 个月）。5 例存在巨大肩袖撕裂的患者接受了反向全肩关节置换术，4 例无肩袖撕裂的患者接受了全肩关节置换术。
影像学检查阴性结果后关节破坏的平均开始时间为 3.1 个月（1.0-5.9 个月）。在平片上，观察到类似割草的肱骨头变平塌陷（100%）。7 例观察到相对较好的肩胛骨关节盂保存，关节间隙正常，2 例（22.2%）观察到肩胛骨关节盂侵蚀。T1 加权磁共振成像显示低信号强度的软骨下骨折（100%），伴有骨髓水肿。组织学上，在软骨下骨折处观察到滑膜的慢性炎症和骨陷窝中的骨细胞，以及骨痂形成。
肩 RDA 的特征是在症状出现后平均 4 个月内出现肱骨头变平塌陷。磁共振成像上观察到骨髓水肿、关节积液和软骨下骨折，组织病理学分析观察到骨折碎片和骨痂形成。2 例出现关节炎进展的患者观察到肩胛骨关节盂侵蚀。
