Kevin Ko Jia-Wei, Syed Usman Ali, Barlow Jonathan D, Paxton Scott, Loeffler Bryan J, Thakar Ocean, Jamgochian Grant, Abboud Joseph A, Getz Charles L, Williams Gerald R
Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Arch Bone Jt Surg. 2019 Jul;7(4):307-313.
Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty. Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either approach.
Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were consecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version, humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views were reviewed to measure corrected inversion and humeral head subluxation.
There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6.8 degrees in the AR group. In the PAG group, version improved 8.8 degrees with 3 mm augment, 13.4 degrees with 5 mm augment, and 12.8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group compared to other groups. The humeral head was re-centered within 6.1% of normal in all groups except 7 mm augments.
This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilized in patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoid retroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study. Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.
在肩关节置换术中，处理肩胛盂后方磨损和后倾仍然是一项挑战。通过使用标准肩胛盂假体进行不对称扩孔（AR）以及使用后方增强型肩胛盂（PAG）假体来纠正肩胛盂后倾是解决该问题的两种方法。我们的目的是报告采用这两种方法治疗的肩胛盂后方磨损和/或后倾患者的影像学结果。
通过回顾性病历审查，连续确定接受AR和标准肩胛盂假体或PAG假体（3mm、5mm或7mm后方增强）治疗的肩胛盂后方磨损且后倾至少15度的患者。术前腋窝位X线片用于评估后倾角度、肱骨头相对于肩胛轴和肩胛盂中央面的半脱位情况。术后腋窝位X线片用于测量纠正后的内翻角度和肱骨头半脱位情况。
AR组有48例患者，PAG组有49例患者。AR组后倾角度改善了6.8度。在PAG组中，3mm增强型假体使后倾角度改善了8.8度，5mm增强型假体使后倾角度改善了13.4度，7mm增强型假体使后倾角度改善了12.8度。与其他组相比，5mm PAG组的中央固定钉穿孔明显更多。除7mm增强型假体组外，所有组的肱骨头均在正常范围内重新居中，偏差率为6.1%。
本研究表明，AR和PAG假体在用于治疗后倾和后方磨损的患者时，有能力使肱骨头重新居中。使用PAG假体可能允许更大程度地纠正肩胛盂后倾，然而，使用本研究中特定的植入物时，中央固定钉穿孔的风险会增加。正在进行长期随访，以了解这些发现的临床意义。
