California Pacific Orthopaedics, San Francisco, CA, USA.
California Pacific Orthopaedics, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2020 Oct;29(10):e386-e393. doi: 10.1016/j.jse.2020.05.009. Epub 2020 Jun 9.
Structural bone graft for reconstruction of glenoid bone stock is often necessary in the setting of revision shoulder arthroplasty. This study introduces a new structural autograft technique using the distal clavicle for treatment of glenoid bone loss in the setting of revision shoulder arthroplasty.
This is a retrospective, single-surgeon study of patients with significant glenoid bone loss requiring revision shoulder arthroplasty with autologous distal clavicle bone grafting to the glenoid. Twenty patients with failed shoulder arthroplasty who underwent revisions of their glenoid components between 2015 and 2019 were retrospectively identified. Sixteen patients were available with follow-up of greater than 1 year. Patient records and radiographs were reviewed for intraoperative and postoperative complications. Preoperative and postoperative function were evaluated by physical examination and patient-reported outcome surveys.
There were no observed intraoperative complications relating to the distal clavicle autograft harvest or placement. There were no iatrogenic nerve injuries or intraoperative instability. One of the 16 patients developed postoperative loosening and subsequent failure of the glenoid baseplate, requiring revision. One additional patient demonstrated increased elevation of the coracoclavicular interval postoperatively, likely related to the distal clavicle autograft harvest. At a mean follow-up of 25 months, 15 of 16 glenoid implants remained well fixed (93.4%), with no evidence of infection, or impingement demonstrated radiographically or clinically. Average patient age was 69 years at the time of surgery. Forward elevation improved from 76° to 123° at final follow-up (P = .0002). The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score improved from an average of 35.8 to 67.8 at mean follow-up (P = .001). The visual analog scale score improved from an average of 5.9 to 2 at mean follow-up, though not statistically significant (P = .068). There was no significant change in external rotation following surgery (P = .319).
Osteolysis and bone loss of the glenoid poses a challenging problem in revision shoulder arthroplasty. Distal clavicle autograft augmentation is a viable and reproducible technique to manage structural glenoid defects.
在肩关节翻修手术中，重建肩盂骨量通常需要结构性骨移植。本研究介绍了一种新的结构性自体移植物技术，使用锁骨远端治疗肩关节翻修术中的肩盂骨量丢失。
这是一项回顾性、单外科医生研究，纳入了 2015 年至 2019 年间因肩盂骨缺损需要接受自体锁骨远端骨移植修复的肩关节翻修术患者。共 20 例患者接受了肩盂假体翻修术，其中 16 例获得了超过 1 年的随访。通过体格检查和患者报告的结果调查评估术前和术后功能。回顾患者病历和影像学资料，记录术中及术后并发症。
无与锁骨远端自体骨移植物采集或放置相关的术中并发症。无医源性神经损伤或术中不稳定。16 例患者中有 1 例术后出现松动，随后肩盂基底部失败，需要翻修。另外 1 例患者术后喙锁间距升高，可能与锁骨远端自体骨采集有关。平均随访 25 个月时，16 例肩盂假体中有 15 例固定良好（93.4%），影像学和临床均未见感染或撞击。手术时患者平均年龄为 69 岁。末次随访时，前屈上举从 76°改善至 123°（P =.0002）。美国肩肘外科医师协会（American Shoulder and Elbow Surgeons，ASES）标准肩关节评估表评分从平均 35.8 分提高至 67.8 分（P =.001）。平均视觉模拟评分（visual analog scale，VAS）从 5.9 分降至 2 分，但差异无统计学意义（P =.068）。术后外旋无明显变化（P =.319）。
肩盂骨溶解和骨丢失是肩关节翻修术的一个挑战。锁骨远端自体骨移植增强是一种可行且可重复的技术，可用于治疗结构性肩盂缺损。
