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全肩关节置换术:概述、适应症及假体选择

TOTAL SHOULDER ARTHROPLASTY, AN OVERVIEW, INDICATINS AND PROSTHETIC OPTIONS.

作者信息

Wicha Mateusz, Tomczyk-Warunek Agnieszka, Jarecki Jaromir, Dubiel Anna

机构信息

CHAIR AND DEPARTMENT OF REHABILITATION AND ORTHOPAEDICS, MEDICAL UNIVERSITY IN LUBLIN, LUBLIN, POLAND.

出版信息

Wiad Lek. 2020;73(9 cz. 1):1870-1873.

Abstract

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indicationsfor this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomictotal shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

摘要

在过去二十年中,肩关节置换术(SA)有了显著改进。它为患有严重肩部功能障碍的患者提供了有效的治疗方法。该手术的适应症最近有了极大扩展。然而,最常见的是盂肱关节骨关节炎、炎性肩部关节病、肩袖撕裂性关节病、肱骨近端复杂骨折以及肱骨头缺血性坏死。手术方式有多种,如肱骨头表面置换、解剖型全肩关节置换术、半肩关节置换术和反式肩关节置换术。所有这些手术都能显著提高患者的生活质量。肩关节置换术在缓解疼痛、显著改善肩部功能及活动方面的效果非常令人满意。然而,该手术不如膝关节或髋关节置换术那么普及。这种现象的原因尚不清楚。并发症发生率相当低。最常见的是假体周围骨折、感染、植入物松动和不稳定。合理的解决办法是转换为反式全肩关节置换术。假体的生存率可达12年,这对患者来说是可以接受的。长期结果仍不明确。进行肩关节置换术的外科医生选择三角肌胸大肌入路,该入路也能为翻修手术提供良好的关节暴露。目的:基于当前文献总结有关肩关节置换术的知识。

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