Lee Julia, Nguyen Ngoc Tram V, Shukla Dave, Sperling John W, Cofield Robert H, Sanchez-Sotelo Joaquin
Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA.
Shoulder Elbow. 2020 Dec;12(1 Suppl):53-60. doi: 10.1177/1758573219859473. Epub 2019 Jul 11.
Upper extremity lymphedema can complicate mastectomy, lymph node dissection, and radiation. The purpose of this study is to present the outcomes of shoulder arthroplasty in patients with lymphedema.
The 19 shoulders with a shoulder arthroplasty and lymphedema on the surgical side (6 anatomic, 12 reverse, 1 hemiarthroplasty) were followed for four years (1-10 years). There were 2 males and 17 females; average age was 67.8 (48-86) years. Breast carcinoma was the most common reason for lymphedema (75%). A dedicated lymphedema questionnaire could be completed for 14 shoulders.
Pain improved from moderate or severe preoperatively to no or mild in 18 shoulders. Motion improved in elevation (55° preoperatively, 107° at last follow-up), external rotation (14°, 43°), and internal rotation (sacrum, L5). Complications included an acromion stress fracture with a deep infection (1), deep infection (1), superficial infection (1), and glenoid loosening (1). Lymphedema worsened in nine cases, but worsening was permanent in only four. Currently, lymphedema treatment is being performed by 93% of survey respondents. No patients reported lymphangitis or lymphangiosarcoma.
Shoulder arthroplasty for an upper extremity with lymphedema provides substantial improvements in pain and motion; however, infection is a concerning complication. Fifty percent of the patients will experience worsening of their lymphedema and in 20% worsening may be permanent.
上肢淋巴水肿会使乳房切除术、淋巴结清扫术和放射治疗变得复杂。本研究的目的是介绍淋巴水肿患者肩关节置换术的结果。
对手术侧行肩关节置换术并伴有淋巴水肿的19例肩部病例（6例解剖型、12例反置型、1例半关节置换术）进行了4年（1 - 10年）的随访。其中男性2例，女性17例；平均年龄67.8岁（48 - 86岁）。乳腺癌是淋巴水肿最常见的原因（75%）。14例肩部病例可完成一份专门的淋巴水肿调查问卷。
18例肩部病例的疼痛程度从术前的中度或重度改善为无或轻度。活动度在抬高（术前55°，末次随访时107°）、外旋（14°，43°）和内旋（骶骨，L5）方面均有改善。并发症包括1例伴有深部感染的肩峰应力骨折、1例深部感染、1例浅表感染和1例关节盂松动。9例淋巴水肿病情加重，但仅4例加重为永久性。目前，93%的调查对象正在进行淋巴水肿治疗。没有患者报告淋巴管炎或淋巴管肉瘤。
上肢淋巴水肿患者行肩关节置换术可显著改善疼痛和活动度；然而，感染是一个令人担忧的并发症。50%的患者淋巴水肿会加重，20%的患者加重可能是永久性的。
