Egger Anthony C, Peterson Jennifer, Jones Morgan H, Miniaci Anthony
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
JSES Open Access. 2019 Sep 13;3(3):145-153. doi: 10.1016/j.jses.2019.07.009. eCollection 2019 Oct.
Glenoid morphology can influence the outcomes of total shoulder arthroplasty. This study examines the results of a new technique according to preoperative glenoid staging. We hypothesized that there would be no statistically significant difference in outcomes between Levine concentric (Walch A) and Levine nonconcentric (Walch B) glenoids treated for primary glenohumeral arthritis using nonspherical humeral head and inlay glenoid replacement.
This retrospective case series included 31 shoulders in 29 patients (25 male, 4 female), with an average age of 58.5 years. Outcomes included the Penn Shoulder Score (PSS), visual analog scale for pain (VAS-Pain), range of motion, radiographic analysis, and complications. Inclusion criteria were primary glenohumeral arthritis, intact rotator cuff, and no prior open shoulder surgeries.
Mean follow-up was 42.6 months (range, 24-74 months). The study included 7 concentric and 24 nonconcentric glenoids. Outcomes comparison showed no statistically significant differences in PSS domains including Pain ( = .92), Function ( = .98), Satisfaction ( = .89), and Total ( = .98); forward flexion ( = .78); external rotation ( = .64); and VAS-Pain ( = 0.12). At the last follow-up, the mean PSS Pain was 25.3/30, Function 52.7/60, Satisfaction 8.4/10, and Total 87.0/100. The mean forward flexion was 167.3°, external rotation 56.6°, and VAS-Pain 0.9. There were no signs of periprosthetic fracture, component loosening, osteolysis, and hardware failure, and no revisions or 90-day rehospitalizations were required. One patient was prophylactically treated with oral antibiotics for a history of prior infection and 1 patient required a later open biceps tenodesis after a traumatic proximal biceps rupture postoperatively.
Nonspherical shoulder arthroplasty with inlay glenoid replacement demonstrated excellent clinical benefits for both concentric and nonconcentric glenoids. The technique appears to be a promising option for glenohumeral arthritis even in the presence of posterior glenoid erosion.
肩胛盂形态可影响全肩关节置换术的疗效。本研究根据术前肩胛盂分期，对一种新技术的结果进行了评估。我们假设，使用非球形肱骨头和嵌体式肩胛盂置换术治疗原发性盂肱关节炎时，Levine同心型（Walch A型）和Levine非同心型（Walch B型）肩胛盂在疗效上无统计学显著差异。
本回顾性病例系列纳入了29例患者（25例男性，4例女性）的31个肩关节，平均年龄58.5岁。疗效指标包括宾夕法尼亚肩关节评分（PSS）、疼痛视觉模拟量表（VAS-疼痛）、活动范围、影像学分析和并发症。纳入标准为原发性盂肱关节炎、肩袖完整且既往无开放性肩关节手术史。
平均随访42.6个月（范围24 - 74个月）。该研究包括7个同心型肩胛盂和24个非同心型肩胛盂。疗效比较显示，在PSS各领域，包括疼痛（P = 0.92）、功能（P = 0.98）、满意度（P = 0.89）和总分（P = 0.98）；前屈（P = 0.78）；外旋（P = 0.64）；以及VAS-疼痛（P = 0.12）方面，均无统计学显著差异。在最后一次随访时，PSS疼痛平均为25.3/30，功能为52.7/60，满意度为8.4/10，总分为87.0/100。平均前屈为167.3°，外旋为56.6°，VAS-疼痛为0.9。无假体周围骨折、假体松动、骨溶解及内固定失败迹象，无需翻修或90天内再次住院治疗。1例有既往感染史的患者接受了口服抗生素预防性治疗，1例患者术后因创伤性肱二头肌近端断裂，后期需要进行开放性肱二头肌肌腱固定术。
采用嵌体式肩胛盂置换的非球形肩关节置换术对同心型和非同心型肩胛盂均显示出良好的临床效果。即使存在肩胛盂后方侵蚀，该技术对于盂肱关节炎似乎也是一个有前景的选择。
