Greenslopes Private Hospital, Brisbane, Australia; Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Australia.
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Australia.
J Shoulder Elbow Surg. 2021 Mar;30(3):599-608. doi: 10.1016/j.jse.2020.09.031. Epub 2020 Nov 2.
Restoration of native glenohumeral joint line is important for a successful outcome after reverse shoulder arthroplasty (RSA). The aims of this study were to quantify the restoration of glenoid joint line after structural bone grafting and RSA, and to evaluate graft incorporation, correction of glenoid version, and rate of notching.
This is a retrospective review of 21 patients who underwent RSA (20 primary, 1 revision) with glenoid bone grafting (15 autografts, 6 allografts). Grammont design implants and baseplate with long peg were used in all patients. Preoperative and postoperative 3D models were created using MIMICS 21.0. Preoperative defects were classified, and postoperative joint line restoration was assessed based on the lateral aspect of the base of the coracoid. Postoperative computed tomographic (CT) scans were evaluated for graft incorporation, version correction, and presence of notching.
Preoperative glenoid defects were classified as massive (5%), large (29%), moderate (52%), and small (14%). The average preoperative version was 8° of retroversion. The average postoperative version was 5° of retroversion. The average preoperative medialization was noted to be 8.4 mm medial to native joint line or 0.6 mm (range -16.8 to 13.2) lateral to the coracoid base. The postoperative CT scans demonstrated a mean joint line at 12.1 mm (range 1.3-22.4) lateral to the coracoid base. At the 3-month follow-up, all patients demonstrated graft incorporation on CT scans. Graft osteolysis was observed on CT scan in 4.8% of patients at a mean follow-up of 19.5 months.
Structural bone grafting of glenoid defect effectively re-creates the glenoid anatomy, restores glenoid bone stock, re-creates the true glenohumeral joint line, and corrects glenoid deformity. The use of bone grafting also allows lateralization of the baseplate and glenosphere, reducing the risk of severe scapular notching.
Restoration of the glenoid joint line was achieved in all patients. Glenoid bone grafting is a viable option for restoring glenoid joint line in cases of significant glenoid defects encountered during RSA.
在反肩关节置换术（RSA）后，恢复原生盂肱关节线对于获得成功的结果非常重要。本研究的目的是定量测量结构性植骨和 RSA 后盂肱关节线的恢复情况，并评估移植物的融合、盂肱关节面倾斜度的纠正以及切迹的发生率。
这是一项对 21 例接受 RSA（20 例初次，1 例翻修）并进行盂肱骨植骨（15 例自体骨，6 例同种异体骨）的患者进行的回顾性研究。所有患者均使用 Grammont 设计的假体和带有长柄的底板。使用 Mimics 21.0 创建术前和术后的 3D 模型。根据喙突基部的外侧，对术前缺损进行分类，并评估术后关节线的恢复情况。
术前盂肱关节面缺损分为巨大（5%）、大（29%）、中度（52%）和小（14%）。平均术前倾斜度为 8°后倾。平均术后倾斜度为 5°后倾。平均术前向内侧移位为 8.4mm 位于原生关节线内侧，或 0.6mm（范围-16.8 至 13.2）位于喙突基部外侧。术后 CT 扫描显示，喙突基部外侧平均关节线位于 12.1mm（范围 1.3-22.4）处。在术后 3 个月的随访中，所有患者在 CT 扫描上均显示移植物融合。在平均 19.5 个月的随访中，4.8%的患者在 CT 扫描上观察到移植物骨溶解。
盂肱关节面缺损的结构性植骨可有效重建盂肱关节解剖结构，恢复盂肱关节面骨量，重建真正的盂肱关节线，并纠正盂肱关节面畸形。植骨的使用还可以使底板和肱骨头向外侧移位，降低严重肩胛切迹的风险。
所有患者的盂肱关节线均得到恢复。在 RSA 中遇到明显的盂肱关节面缺损时，盂肱关节面植骨是恢复盂肱关节线的可行选择。
