Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Georgetown University School of Medicine, Washington, DC, USA.
J Shoulder Elbow Surg. 2021 May;30(5):1060-1067. doi: 10.1016/j.jse.2020.08.002. Epub 2020 Aug 24.
Complex glenoid bone loss and deformity present a challenge for the shoulder arthroplasty surgeon. Eccentric reaming, bone grafting, augmented glenoid components, and salvage hemiarthroplasty are common strategies for managing these patients. The glenoid vault reconstruction system (VRS; Zimmer-Biomet) is a novel solution for both primary and revision arthroplasty using a custom glenoid baseplate. We hypothesized that patients undergoing reverse shoulder arthroplasty (RSA) with VRS would have acceptable short-term outcomes and complication rates.
Patients who underwent RSA with VRS for severe glenoid deformity or bone loss by one of 4 board-certified, fellowship-trained shoulder and elbow surgeons at 3 academic tertiary referral centers between September 2015 and November 2018 were eligible for inclusion. Patient data were obtained via medical record review and telephone questionnaires. The Numeric Pain Rating Scale (NPRS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Penn Shoulder Scores, and range of motion (ROM) measurements were obtained pre- and postoperatively. Radiographs were reviewed at final follow-up for evidence of component loosening or hardware failure. Any complication was documented. Outcomes were compared using Wilcoxon signed-rank tests with P <. 05 considered significant.
Twelve shoulders (11 patients) were included with a mean age of 68 years; 7 were primary arthroplasties and 5 were revisions. At an average follow-up time of 30 months, median improvement in NPRS score was 7 points, SANE score 43%, ASES score 45 points, and Penn Shoulder Score 49 points. There were statistically significant improvements in median ROM measurements (forward elevation 20°, external rotation 40°, internal rotation 2 spinal levels). At final follow-up, all implants were radiographically stable without loosening. There were no complications.
This study demonstrates that RSA using the custom VRS glenoid implant is a safe and effective technique addressing complex glenoid deformity or bone loss in both primary and revision settings. At short-term follow-up, all patient-reported outcomes and ROM measures improved significantly, and there were no complications. Future work should determine mid- and long-term outcomes, preferably in a prospective manner with defined patient populations.
复杂的肩胛盂骨丢失和畸形给肩关节置换术医生带来了挑战。偏心扩孔、植骨、增强型肩胛盂假体和挽救性半肩关节置换术是治疗这些患者的常见策略。VRS（Zimmer-Biomet）肩胛盂穹顶重建系统是一种用于初次和翻修肩关节置换术的新型解决方案，使用定制的肩胛盂基底部。我们假设接受 VRS 反向肩关节置换术（RSA）的患者将具有可接受的短期结果和并发症发生率。
在 2015 年 9 月至 2018 年 11 月期间，由 4 位经过认证的、 fellowship培训的肩部和肘部外科医生中的 1 位在 3 家学术性三级转诊中心对因严重肩胛盂畸形或骨丢失而接受 RSA 的患者进行 VRS 治疗。通过病历回顾和电话问卷调查获得患者数据。术前和术后分别获得数字疼痛评分量表（NPRS）、单一评估数字评估（SANE）、美国肩肘外科医生肩关节评估标准表（ASES）、Penn 肩关节评分和活动范围（ROM）测量值。在最后一次随访时，对 X 线片进行评估，以确定是否存在组件松动或硬件故障。记录任何并发症。使用 Wilcoxon 符号秩检验比较结果，P<.05 为差异有统计学意义。
纳入了 12 个肩关节（11 例患者），平均年龄为 68 岁；7 例为初次置换，5 例为翻修。平均随访 30 个月，NPRS 评分中位数改善 7 分，SANE 评分改善 43%，ASES 评分改善 45 分，Penn 肩关节评分改善 49 分。ROM 测量值的中位数有显著改善（前屈 20°，外展 40°，内旋 2 个脊柱节段）。在最后一次随访时，所有植入物均无放射学松动。无并发症。
本研究表明，在初次和翻修手术中，使用定制 VRS 肩胛盂植入物的 RSA 是一种安全有效的技术，可治疗复杂的肩胛盂畸形或骨丢失。在短期随访中，所有患者报告的结果和 ROM 测量值均显著改善，且无并发症。未来的研究应确定中期和长期结果，最好采用前瞻性方法，并针对特定的患者人群进行研究。
