预测行解剖型和反式全肩关节置换术后患者报告的结局指标及活动范围的术前参数。
Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty.
作者信息
Friedman Richard J, Eichinger Josef, Schoch Bradley, Wright Thomas, Zuckerman Joseph, Flurin Pierre-Henri, Bolch Charlotte, Roche Chris
机构信息
Medical University of South Carolina, Charleston, SC, USA.
University of Florida Orthopaedics, Gainesville, FL, USA.
出版信息
JSES Open Access. 2019 Nov 18;3(4):266-272. doi: 10.1016/j.jses.2019.09.010. eCollection 2019 Dec.
BACKGROUND
Preoperative factors that most influence postoperative outcomes of both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are unknown. The purpose of this study was to identify the preoperative parameters that significantly influence postoperative outcomes of aTSA and rTSA.
METHODS
The outcomes of 1089 aTSA patients and 1332 rTSA patients (mean follow-up period, 49 months) from an international registry with a single platform system were analyzed. A multiple linear regression model with backward stepwise selection identified the preoperative parameters that were significant predictors of postoperative clinical outcome metric scores and motion measures for both rTSA and aTSA.
RESULTS
For both aTSA and rTSA patients, numerous preoperative parameters that influence postoperative outcomes were identified. Greater postoperative range of motion (ROM) was significantly influenced by greater preoperative ROM. For aTSA, greater postoperative American Shoulder and Elbow Surgeons (ASES) scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, and the presence of greater preoperative active external rotation. For rTSA, greater postoperative ASES scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, no history of tobacco use, less preoperative passive external rotation, and greater preoperative active external rotation.
CONCLUSIONS
This study quantified the preoperative predictors of postoperative clinical outcome metric scores and ROM for both aTSA and rTSA. Numerous significant associations were identified, including demographic and comorbidity risk factors. These associations may be helpful for surgeons to consider when counseling patients regarding aTSA versus rTSA and to establish more accurate expectations prior to surgery.
背景
目前尚不清楚对解剖型全肩关节置换术（aTSA）和反式全肩关节置换术（rTSA）术后结果影响最大的术前因素。本研究的目的是确定对aTSA和rTSA术后结果有显著影响的术前参数。
方法
分析了来自一个具有单一平台系统的国际注册机构的1089例aTSA患者和1332例rTSA患者（平均随访期49个月）的结果。采用向后逐步选择的多元线性回归模型确定术前参数，这些参数是rTSA和aTSA术后临床结果指标评分和活动度测量的重要预测因素。
结果
对于aTSA和rTSA患者，均确定了许多影响术后结果的术前参数。术前活动度越大，术后活动度范围（ROM）越大。对于aTSA，术后美国肩肘外科医师（ASES）评分越高，术前ASES评分越高、无肩部手术史以及术前主动外旋角度越大有显著影响。对于rTSA，术后ASES评分越高，术前ASES评分越高、无肩部手术史、无吸烟史、术前被动外旋角度越小以及术前主动外旋角度越大有显著影响。
结论
本研究量化了aTSA和rTSA术后临床结果指标评分和ROM的术前预测因素。确定了许多显著关联，包括人口统计学和合并症风险因素。这些关联可能有助于外科医生在为患者提供aTSA与rTSA咨询时加以考虑，并在手术前建立更准确的预期。
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