Dekker Andrew P, Joshi Nirad, Morgan Marie, Espag Marius, A Tambe Amol, Clark David I
Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
J Clin Orthop Trauma. 2020 Mar;11(Suppl 2):S265-S269. doi: 10.1016/j.jcot.2019.05.014. Epub 2019 May 22.
Medium-term clinical results and survival of the Copeland resurfacing hemiarthroplasty of the shoulder (CRHA) in a large consecutive group are presented with a comparison of outcomes for underlying pathologies.
A consecutive series of patients undergoing CRHA over 14 years was retrospectively analysed with no exclusions. Patients had a minimum 2-year follow-up by an independent assessor. Functional outcome was assessed using the Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). Pain and satisfaction was assessed using a visual analogue score.
279 CRHAs were performed in 242 patients between 2002 and 2016. The mean follow-up was 6 years. The indication for surgery was osteoarthritis (OA) in 212, inflammatory arthropathy (RA) in 35, rotator cuff tear arthropathy (CTA) in 22 and avascular necrosis (AVN) in 2. For the OA group, 5-year survival was 90%, 10-year survival was 83% and mean survival was 13.2 years (95% CI 12.5-13.9). The mean OSS was 35.0 and mean CMS 49.9. CRHA for CTA had significantly poorer (p < 0.001) 5-year survival (55%), 10-year survival (41%) and mean survival (5.9 years, 95% CI 4.7-7.2). Mean OSS was 23.6 and mean CMS 30.3, which was poorer than for OA (p < 0.001). A subgroup analysis of OA patients found significantly better survival (p = 0.013) in those aged over 65 years but no difference in functional outcome.
CRHA remains a reasonable option for OA in patients with an intact rotator cuff and with sufficient bone stock, especially in those aged over 65 years. With poorer functional outcomes and survival, CRHA should not be offered in those with CTA.
Level III (retrospective comparative study).
本文报告了连续大量患者接受肩关节Copeland表面置换半关节成形术（CRHA）的中期临床结果和生存率，并对不同潜在病理情况的预后进行了比较。
回顾性分析了连续14年接受CRHA的一系列患者，无排除病例。患者由独立评估者进行至少2年的随访。使用牛津肩部评分（OSS）和Constant-Murley评分（CMS）评估功能结果。使用视觉模拟评分评估疼痛和满意度。
2002年至2016年间，242例患者接受了279次CRHA手术。平均随访时间为6年。手术指征为骨关节炎（OA）212例、炎性关节病（RA）35例、肩袖撕裂关节病（CTA）22例和缺血性坏死（AVN）2例。OA组5年生存率为90%，10年生存率为83%，平均生存率为13.2年（95%CI 12.5-13.9）。平均OSS为35.0，平均CMS为49.9。CTA患者的CRHA 5年生存率（55%）、10年生存率（41%）和平均生存率（5.9年，95%CI 4.7-7.2）明显较差（p<0.001）。平均OSS为23.6，平均CMS为30.3，低于OA组（p<0.001）。对OA患者的亚组分析发现，65岁以上患者的生存率明显更高（p=0.013），但功能结果无差异。
对于肩袖完整且骨量充足的OA患者，尤其是65岁以上患者，CRHA仍然是一个合理的选择。对于CTA患者，由于功能结果和生存率较差，不应采用CRHA。
三级（回顾性比较研究）。
