Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zuerich, Switzerland.
BMC Musculoskelet Disord. 2020 May 12;21(1):295. doi: 10.1186/s12891-020-03277-3.
Stemless total shoulder arthroplasty is a well-established and reliable surgical treatment option for glenohumeral osteoarthritis resulting in loss of pain and improvement of shoulder function. Currently the two methods for the fixation of the humeral component are either screw fixation or impaction. The purpose of this study is the clinical and radiological comparison of two different stemless designs (screw fixation vs impaction) for total shoulder arthroplasties in patients suffering from primary glenohumeral osteoarthritis.
A retrospective cohort study including 39 patients with a mean age of 67 years and a minimum follow-up of 2 years was performed. Patients were separated into two groups based on the selected implant. In group A (n = 18) a screw fixation design and in group B (n = 21) an impaction type design was used. For clinical examination the Constant-Murley-Score (CS) and Subjective-Shoulder-Value (SSV) were evaluated. Radiological examination was performed on true-AP, axial and Y-view radiographs.
In group A the CS increased from 27.1 to 65.2 points and SSV from 27.3 to 76.7% (p > 0.05). No osteolysis of the medial calcar or subsidence of the humeral implant were found in this group. In group B the CS increased from 29.0 to 72.6 points and SSV from 33.1 to 85% (p < 0.05). Osteolysis of the medial calcar was present in seven patients in this group. No signs for humeral loosening were found in both groups.
Impaction and screw fixation total shoulder arthroplasty for primary glenohumeral osteoarthritis using a stemless device provide reliable clinical results. The screw fixation seems to prevent osteolysis of the medial calcar.
对于因肩袖关节病导致的疼痛和功能丧失的肩关节炎，采用无柄全肩关节置换术是一种成熟且可靠的治疗选择。目前，固定肱骨头的两种方法是螺钉固定或压配固定。本研究的目的是对两种不同的无柄设计（螺钉固定与压配固定）在原发性肩袖关节病患者中的全肩关节置换进行临床和影像学比较。
对 39 例患者进行了回顾性队列研究，患者平均年龄为 67 岁，随访时间至少为 2 年。根据所选植入物将患者分为两组。A 组（n=18）采用螺钉固定设计，B 组（n=21）采用压配型设计。采用 Constant-Murley 评分（CS）和主观肩部评分（SSV）对临床检查进行评估。影像学检查采用真前后位、轴向和 Y 位片。
在 A 组中，CS 从 27.1 分增加到 65.2 分，SSV 从 27.3%增加到 76.7%（p>0.05）。在该组中未发现内侧骨突骨溶解或肱骨头植入物下沉。在 B 组中，CS 从 29.0 分增加到 72.6 分，SSV 从 33.1%增加到 85%（p<0.05）。在该组中有 7 例患者出现内侧骨突骨溶解。在两组中均未发现肱骨头松动的迹象。
使用无柄装置的原发性肩袖关节病的压配固定和螺钉固定全肩关节置换可提供可靠的临床结果。螺钉固定似乎可以预防内侧骨突骨溶解。
