Barlow Jonathan D, Jamgochian Grant, Wells Zachary, Bateman Dexter Kenneth, Schmerfeld Amber A, Abboud Joseph A, Williams Gerald R
The Mayo Clinic, Rochester, MN.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Arch Bone Jt Surg. 2020 Jan;8(1):75-82. doi: 10.22038/abjs.2019.38427.2016.
It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patients with cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90˚).
This was a retrospective, single institution study. Patients who underwent RSA or HA for CTA were included if they had preserved preoperative motion with a minimum of 2 years of follow-up, or until complication/revision. Shoulder ROM and functional outcomes scores were obtained.
Twenty-six HAs and 21 RSAs were evaluated at mean of 38.6 months (HA) and 36.3 months (RSA). Patients in the RSA group were significantly older at surgery (73.9 versus 65.1 years; ). Postoperatively, the mean change in active elevation was -15° for HA versus 26° for RSA, with RSA having significantly greater active elevation (153° versus 123°; ). There were no significant differences in final internal or external rotation between groups. Superior outcomes were seen for RSA versus HA for ASES score (84 vs. 66, P=0.003), Simple Shoulder Test (8.8 vs. 7.3, ), Single Assessment Numeric Evaluation (85 vs. 70, ), and 100mm VAS pain (7 vs. 33, ).
In patients with CTA and preserved preoperative forward elevation, RSA provided greater pain relief, superior functional outcomes, and better ROM compared with HA.
对于存在肩袖撕裂关节病（CTA）且术前活动度保留（抬高>90˚）的患者，半关节置换术（HA）或反肩关节置换术（RS）哪种更具优势尚不清楚。
这是一项单机构的回顾性研究。纳入因CTA接受RSA或HA治疗且术前活动度保留、随访至少2年或直至出现并发症/翻修的患者。获取肩部活动范围（ROM）和功能结局评分。
共评估了26例HA和21例RSA，平均随访时间分别为38.6个月（HA）和36.3个月（RSA）。RSA组患者手术时年龄显著更大（73.9岁对65.1岁）。术后，HA组主动抬高的平均变化为-15°，而RSA组为26°，RSA组的主动抬高显著更高（153°对123°）。两组之间最终的内旋或外旋无显著差异。在ASES评分（84对66，P = 0.003）、简易肩关节测试（8.8对7.3）、单评估数字评价（85对70）和100mm视觉模拟评分疼痛（7对33）方面，RSA组的结局优于HA组。
对于存在CTA且术前前向抬高保留的患者，与HA相比，RSA能提供更好的疼痛缓解、更优的功能结局和更好的ROM。
