Casa Di Cura Villa Betania, Rome, Italy.
Marrelli Hospital, Crotone, Italy.
Arch Orthop Trauma Surg. 2020 Dec;140(12):1891-1900. doi: 10.1007/s00402-020-03400-y. Epub 2020 Mar 5.
Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy. Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty. Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates. The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis.
A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Ovid, Cochrane Reviews, and Google Scholar were comprehensively searched using a combination of the following keywords: shoulder arthroplasty, reverse shoulder arthroplasty, dislocation arthropathy, capsulorrhaphy arthropathy and stabilization procedures.
Thirteen studies with 365 patients met inclusion criteria. Since 13 patients were lost to follow-up, 352 were reviewed at an average follow-up of 53.4 months. The average Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scores improved from 35.6 and 35.7 to 72.7 and 77, respectively. The overall complication rate was 25.7% and the reoperation rate was 18.5%. Radiographs at follow-up revealed radiolucent lines on the humerus in 12.4% of cases and radiolucent lines or notching on the glenoid side in 22.7% of cases. The average Methodological Index for Non-randomized Studies Score (MINORS) was 12.9 for non-comparative studies and 21.3 for comparative studies.
Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology. Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis; however, the difference is not statistically significant. When reverse shoulder arthroplasties (RSA) were considered as a subgroup and compared to anatomic shoulder replacements (total shoulders and hemiarthroplasties), they showed a lower revision rate.
慢性盂肱关节前向不稳定是一种常见情况，可导致进行性软骨恶化，最终发展为不稳定性关节病。尽管采用了保守或手术治疗，仍可能发生进行性软骨恶化，这些情况的后遗症通常采用全肩关节置换术来处理。本研究的目的是分析现有文献，描述该特殊手术的技术方面，并报告结果和并发症发生率。假设不稳定后遗症的肩关节置换术的结果低于原发性关节炎的关节置换术，且并发症发生率更高。
根据 PRISMA 指南，对文献进行系统回顾。使用以下关键词的组合，全面搜索 PubMed、Ovid、Cochrane Reviews 和 Google Scholar：肩关节置换术、反式肩关节置换术、脱位性关节病、囊紧缩成形术关节病和稳定术。
符合纳入标准的 13 项研究共纳入 365 例患者。由于 13 例患者失访，在平均随访 53.4 个月时，共 352 例患者得到了回顾。平均 Constant-Murley（CM）和美国肩肘协会（ASES）评分分别从 35.6 和 35.7 提高到 72.7 和 77。总的并发症发生率为 25.7%，再次手术率为 18.5%。随访时 X 线片显示肱骨侧有透亮线 12.4%，肩胛盂侧有透亮线或切迹 22.7%。非随机研究方法学指数（MINORS）的平均分数为 12.9 分（非对照研究）和 21.3 分（对照研究）。
肩关节置换术治疗不稳定性关节病和稳定术的后遗症是一项具有挑战性的手术，这是由于解剖结构扭曲和严重的盂肱关节病理所致。与原发性肩关节炎的肩关节置换术相比，并发症和再次手术率更高；然而，差异无统计学意义。当反式肩关节置换术（RSA）被视为亚组，并与解剖型肩关节置换术（全肩关节置换术和半肩关节置换术）进行比较时，它们的翻修率较低。
