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肩胛切迹对反式全肩关节置换术后临床结果的影响。

Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty.

机构信息

Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.

出版信息

Bone Joint J. 2020 Nov;102-B(11):1438-1445. doi: 10.1302/0301-620X.102B11.BJJ-2020-0449.R1.


DOI:10.1302/0301-620X.102B11.BJJ-2020-0449.R1
PMID:33135432
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7954180/
Abstract

AIMS: Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. METHODS: Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD). RESULTS: In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD -3.11; 95% confidence interval (CI) -4.98 to -1.23), the ASES score (WMD -6.50; 95% CI -10.80 to -2.19), FF (WMD -6.3°; 95% CI -9.9° to -2.6°), and abduction (WMD -9.4°; 95% CI -17.8° to -1.0°), but not for ER (WMD -0.6°; 95% CI -3.7° to 2.5°). CONCLUSION: The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: 2020;102-B(11):1438-1445.

摘要

目的:肩胛切迹被认为对反式全肩关节置换术(RTSA)的结果有不利影响。然而,这个问题仍存在争议。本研究旨在确定肩胛切迹对 RTSA 后结果的临床影响。

方法:检索了三个电子数据库(PubMed、Cochrane 数据库和 EMBASE),以评估肩胛切迹对 RTSA 后临床结果影响的研究。评估了每项研究的质量。提取了功能结果评分(Constant-Murley 评分(CMS)和美国肩肘外科医师协会(ASES)评分)和术后活动范围(前屈(FF)、外展和外旋(ER)),并进行了荟萃分析。效应大小表示为加权均数差(WMD)。

结果:共有 11 项研究(2 项 3 级和 9 项 4 级)被纳入荟萃分析。所有分析变量均表明肩胛切迹对 RTSA 的结果有负面影响。CMS(WMD=-3.11;95%置信区间(CI)-4.98 至-1.23)、ASES 评分(WMD=-6.50;95%CI-10.80 至-2.19)、FF(WMD=-6.3°;95%CI-9.9°至-2.6°)和外展(WMD=-9.4°;95%CI-17.8°至-1.0°)具有统计学意义,但 ER 无统计学意义(WMD=-0.6°;95%CI-3.7°至 2.5°)。

结论:目前的文献表明,RTSA 后存在肩胛切迹的患者,其 CMS、ASES 评分和 FF 及外展活动范围明显较差。

引用本文:2020;102-B(11):1438-1445.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/ccdf4b94b8eb/BJJ-102B-1438-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/d153605f0376/BJJ-102B-1438-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/5cbe5d97b02f/BJJ-102B-1438-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/96a71abea446/BJJ-102B-1438-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/ccdf4b94b8eb/BJJ-102B-1438-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/d153605f0376/BJJ-102B-1438-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/5cbe5d97b02f/BJJ-102B-1438-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/96a71abea446/BJJ-102B-1438-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d0/7954180/ccdf4b94b8eb/BJJ-102B-1438-g0004.jpg

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[Influencing factors on effectiveness of reverse total shoulder arthroplasty].

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本文引用的文献

[1]
Can small glenospheres with eccentricity reduce scapular notching as effectively as large glenospheres without eccentricity? A prospective randomized study.

J Shoulder Elbow Surg. 2019-11-26

[2]
Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty.

Bone Joint Res. 2019-9-3

[3]
Impact of scapular notching on reverse total shoulder arthroplasty midterm outcomes: 5-year minimum follow-up.

J Shoulder Elbow Surg. 2019-7-13

[4]
Prognostic Radiological Factors Affecting Clinical Outcomes of Reverse Shoulder Arthroplasty in the Korean Population.

Clin Orthop Surg. 2019-2-18

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Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal-backed prosthesis: the first 45 sequential cases at a minimum of two years’ follow-up.

Bone Joint J. 2018-12

[6]
Reverse shoulder arthroplasty for fracture sequelae: Clinical outcome and prognostic factors.

J Orthop Sci. 2019-3

[7]
Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up.

J Orthop Surg Res. 2018-10-16

[8]
Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty.

Bone Joint J. 2018-9

[9]
Quantifying success after total shoulder arthroplasty: the minimal clinically important difference.

J Shoulder Elbow Surg. 2017-11-20

[10]
Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Before the Age of 60 Years: Long-Term Results.

J Bone Joint Surg Am. 2017-10-18

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