Murthi Anand M, Cox Ryan M, Strelzow Jason A, Athwal George S, Tashjian Robert Z, Abboud Joseph A
Chief of Shoulder and Elbow Surgery, Department of Orthopaedics, MedStar Union Memorial Hospital, Baltimore, Maryland.
Instr Course Lect. 2018 Feb 15;67:99-113.
The management of glenohumeral arthritis in young patients is a challenge given the higher demand for use of the arms, need for longer implant survivorship, and higher postoperative expectations in this patient population. Shoulder arthroplasty is an excellent treatment option for elderly patients with glenohumeral arthritis because this patient population does not have demands as high as those of younger patients with glenohumeral arthritis. Common causes of glenohumeral arthritis in young patients include chondrolysis, inflammatory arthropathies, chronic instability, osteonecrosis, glenoid dysplasia, and early-onset osteoarthritis. Options for the surgical management of glenohumeral arthritis in young patients include arthroscopic débridement with or without capsular release, biceps tenodesis, chondroplasty, and/or subacromial decompression; soft-tissue resurfacing; humeral head resurfacing; anatomic total shoulder arthroplasty; reverse total shoulder arthroplasty; and glenohumeral arthrodesis. Shoulder arthroplasty is the preferred treatment for young patients with glenohumeral arthritis; however, surgeons must counsel patients on treatment options, surgical goals, postoperative functional expectations, and the potential for future surgery to increase the likelihood of good outcomes.
鉴于年轻患者对上肢使用的需求更高、对植入物更长使用寿命的需求以及该患者群体更高的术后期望，年轻患者的盂肱关节炎管理是一项挑战。对于患有盂肱关节炎的老年患者，肩关节置换术是一种极佳的治疗选择，因为该患者群体的需求不像患有盂肱关节炎的年轻患者那么高。年轻患者盂肱关节炎的常见病因包括软骨溶解、炎性关节病、慢性不稳定、骨坏死、关节盂发育不良和早发性骨关节炎。年轻患者盂肱关节炎的手术管理选择包括有或无关节囊松解的关节镜清创、肱二头肌固定术、软骨成形术和/或肩峰下减压；软组织表面重建；肱骨头表面重建；解剖型全肩关节置换术；反置全肩关节置换术；以及盂肱关节融合术。肩关节置换术是年轻盂肱关节炎患者的首选治疗方法；然而，外科医生必须就治疗选择、手术目标、术后功能期望以及未来手术的可能性向患者提供咨询，以提高获得良好结果的可能性。
