iULS (Institut Universitaire Locomoteur et du Sport) Hôpital Pasteur 2, University Côte d'Azur, Nice, France.
Department of Anesthesiology, Hôpital Pasteur 2, University Côte d'Azur, Nice, France.
J Shoulder Elbow Surg. 2020 Jan;29(1):e1-e10. doi: 10.1016/j.jse.2019.05.044. Epub 2019 Aug 23.
We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years.
Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years. The cause was primary osteoarthritis (18), fracture sequelae (16), post-instability arthritis (15), aseptic necrosis (3), inflammatory disease (2), and failed hemiarthroplasty (4); 34 shoulders (61%) had previously undergone surgery. Glenoid erosion was assessed in 4 grades according to the Sperling classification. Humeral erosion was also assessed in 4 grades. Multivariate analysis was used to determine predisposing risk factors for both humeral and glenoid erosion.
At a mean follow-up of 47 ± 15 months, survival rate was 90%. Six patients (10%) required conversion to reverse total shoulder prosthesis for painful glenoid erosion (n = 2) and humeral erosion with greater tuberosity stress fractures (n = 4). The mean Constant score and subjective shoulder value significantly increased from 36 ± 14 points to 70 ± 15 points and 32% ± 14% to 75% ± 19%, respectively (P < .001). Humeral medialization was observed in 78% of the cases with increased pain score. Uncorrected anteroposterior implant subluxation (12 cases) was associated with lower Constant score (50 points vs. 72 points; P = .02) and lower subjective shoulder value (53% vs. 78%; P = .002). On multivariate analysis, no risk factors for glenoid or humeral erosion were found.
At midterm follow-up, PISA does not protect from progressive glenoid erosion and can lead to greater tuberosity erosion and stress fractures. Longer follow-up is required to see whether PISA survival will be superior to that of hemiarthroplasty.
我们评估了小于 65 岁关节炎患者行高温碳化硅（Pyrocarbon）间置肩假体置换术（PISA）的生存情况和中期结果。
2010 年至 2015 年间，前瞻性观察了 56 例患者共 58 例 PISA（InSpyre；Tornier-Wright，明尼苏达州布鲁明顿）。手术时的平均年龄为 52 ± 13 岁。病因包括原发性骨关节炎（18 例）、骨折后遗症（16 例）、不稳定后关节炎（15 例）、无菌性坏死（3 例）、炎性疾病（2 例）和半肩置换失败（4 例）；34 例（61%）有既往手术史。根据 Sperling 分类，评估肩盂侵蚀 4 级，肱骨头侵蚀 4 级。采用多变量分析确定肱骨头和肩盂侵蚀的易患风险因素。
平均随访 47 ± 15 个月时，生存率为 90%。6 例（10%）因疼痛性肩盂侵蚀（2 例）和肱骨头侵蚀伴大结节应力性骨折（4 例）而转为反式全肩关节置换。Constant 评分和主观肩关节评分分别从 36 ± 14 分显著提高至 70 ± 15 分和 32% ± 14%至 75% ± 19%（P <.001）。78%的病例出现肱骨头内侧化，疼痛评分增加。未矫正的前后向假体半脱位（12 例）与较低的 Constant 评分（50 分 vs. 72 分；P =.02）和较低的主观肩关节评分（53% vs. 78%；P =.002）相关。多变量分析未发现肩盂或肱骨头侵蚀的危险因素。
中期随访发现，PISA 并不能防止肩盂进行性侵蚀，反而可能导致大结节侵蚀和应力性骨折。需要更长时间的随访来观察 PISA 的生存率是否优于半肩置换。
