Chawla Harshvardhan, Gamradt Seth
Sports Medicine Service, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USA.
Curr Rev Musculoskelet Med. 2020 Apr;13(2):180-185. doi: 10.1007/s12178-020-09613-3.
The goal of this review is to introduce surgical decision-making pearls for reverse shoulder arthroplasty and describe optimization of surgical exposure for reverse shoulder arthroplasty.
While the technology of reverse shoulder replacement and the associated prosthetic options have expanded, the principles involved in successfully exposing the humerus and glenoid in arthroplasty remain the same. Reverse shoulder replacement should be considered in arthroplasty situations with rotator cuff disease, deformity, bone loss, and instability as part of the diagnosis. Optimal exposure in reverse shoulder arthroplasty can be obtained by (1) releasing deltoid adhesions, (2) removal of humeral osteophytes, (3) generous humeral head cuts, (4) thorough humeral and glenoid capsular release and (5) optimal glenoid retractor placement. Neuromuscular paralysis can also aid glenoid exposure.
本综述的目的是介绍反向肩关节置换术的手术决策要点，并描述反向肩关节置换术手术显露的优化方法。
虽然反向肩关节置换技术及相关假体选择有所增加，但在关节置换术中成功显露肱骨和肩胛盂所涉及的原则仍保持不变。在诊断为肩袖疾病、畸形、骨质流失和不稳定的关节置换情况下，应考虑进行反向肩关节置换。通过以下方法可实现反向肩关节置换术的最佳显露：（1）松解三角肌粘连，（2）去除肱骨骨赘，（3）进行充分的肱骨头截骨，（4）彻底松解肱骨和肩胛盂的关节囊，（5）最佳放置肩胛盂牵开器。神经肌肉麻痹也有助于肩胛盂的显露。
