Chelli Mikaël, Lo Cunsolo Lucas, Gauci Marc-Olivier, Gonzalez Jean-François, Domos Peter, Bronsard Nicolas, Boileau Pascal
Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France.
Royal Free London NHS Foundation Trust, London, UK.
JSES Open Access. 2019 Sep 11;3(3):162-167. doi: 10.1016/j.jses.2019.06.003. eCollection 2019 Oct.
Reverse shoulder arthroplasty (RSA) is offered to young patients with a failed previous arthroplasty or a cuff-deficient shoulder, but the overall results are still uncertain. We conducted a systematic review of the literature to report the midterm outcomes and complications of RSA in patients younger than 65 years.
A search of the MEDLINE and Cochrane electronic databases identified clinical studies reporting the results, at a minimum 2-year follow-up, of patients younger than 65 years treated with an RSA. The methodologic quality was assessed with the Methodological Index for Non-Randomized Studies score by 2 independent reviewers. Complications, reoperations, range of motion, functional scores, and radiologic outcomes were analyzed.
Eight articles were included, with a total of 417 patients. The mean age at surgery was 56 years (range, 21-65 years). RSA was used as a primary arthroplasty in 79% of cases and revision of a failed arthroplasty in 21%. In primary cases, the indications were cuff tear arthropathy and/or massive irreparable cuff tear in 72% of cases. The overall complication rate was 17% (range, 7%-38%), with the most common complications being instability (5%) and infection (4%). The reintervention rate was 10% at 4 years, with implant revision in 7% of cases. The mean weighted American Shoulder and Elbow Surgeons score, active forward elevation, and external rotation were 64 points, 121°, and 29°, respectively.
RSA provides reliable clinical improvements in patients younger than 65 years with a cuff-deficient shoulder or failed arthroplasty. The complication and revision rates are comparable to those in older patients.
对于先前关节置换失败或存在肩袖缺损的年轻患者，可采用反式肩关节置换术（RSA），但其总体效果仍不明确。我们对文献进行了系统回顾，以报告65岁以下患者RSA的中期疗效及并发症情况。
检索MEDLINE和Cochrane电子数据库，确定临床研究报告了至少随访2年的65岁以下接受RSA治疗患者的结果。由2名独立评审员使用非随机研究方法学指数评分评估方法学质量。分析并发症、再次手术情况、活动范围、功能评分和影像学结果。
纳入8篇文章，共417例患者。手术时的平均年龄为56岁（范围21 - 65岁）。79%的病例中RSA用作初次关节置换术，21%用于翻修失败的关节置换术。在初次病例中，72%的病例适应证为肩袖撕裂性关节病和/或巨大不可修复的肩袖撕裂。总体并发症发生率为17%（范围7% - 38%），最常见的并发症为不稳定（5%）和感染（4%）。4年时再次干预率为10%，7%的病例进行了植入物翻修。美国肩肘外科医师协会平均加权评分、主动前屈和外旋分别为64分、121°和29°。
对于65岁以下肩袖缺损或关节置换失败的患者，RSA能带来可靠的临床改善。并发症和翻修率与老年患者相当。
