Matsen Frederick A, Whitson Anastasia J, Somerson Jeremy S, Hsu Jason E
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.
The University of Texas Medical Branch, Galveston, Texas.
JB JS Open Access. 2020 Nov 17;5(4). doi: 10.2106/JBJS.OA.20.00002. eCollection 2020 Oct-Dec.
This study evaluated the ability of shoulder arthroplasty using a standard glenoid component to improve patient self-assessed comfort and function and to correct preoperative humeral-head decentering on the face of the glenoid in patients with primary glenohumeral arthritis and type-B2 or B3 glenoids.
We identified 66 shoulders with type-B2 glenoids (n = 40) or type-B3 glenoids (n = 26) undergoing total shoulder arthroplasties with a non-augmented glenoid component inserted without attempting to normalize glenoid version and with clinical and radiographic follow-up that was a minimum of 2 years. The Simple Shoulder Test (SST), the percentage of humeral-head decentering on the glenoid face, and bone ingrowth into the central peg were the main outcome variables of interest. Similar analyses were made for concurrent patients with type-A1, A2, B1, and D glenoid pathoanatomy to determine if the outcomes for type-B2 and B3 glenoids were inferior to those for the other types.
The SST score (and standard deviation) improved from 3.2 ± 2.1 points preoperatively to 9.9 ± 2.4 points postoperatively (p < 0.001) at a mean time of 2.8 ± 1.2 years for type-B2 glenoids and from 3.0 ± 2.5 points preoperatively to 9.4 ± 2.1 points postoperatively (p < 0.001) at a mean time of 2.9 ± 1.5 years for type-B3 glenoids; these results were not inferior to those for shoulders with other glenoid types. Postoperative glenoid version was not significantly different (p > 0.05) from preoperative glenoid version. The mean humeral-head decentering on the glenoid face was reduced for type-B2 glenoids from -14% ± 7% preoperatively to -1% ± 2% postoperatively (p < 0.001) and for type-B3 glenoids from -4% ± 6% preoperatively to -1% ± 3% postoperatively (p = 0.027). The rates of bone integration into the central peg for type-B2 glenoids (83%) and type-B3 glenoids (81%) were not inferior to those for other glenoid types.
Shoulder arthroplasty with a standard glenoid inserted without changing version can significantly improve patient comfort and function and consistently center the humeral head on the glenoid face in shoulders with type-B2 and B3 glenoids, achieving >80% osseous integration into the central peg. These clinical and radiographic outcomes for type-B2 and B3 glenoids were not inferior to those outcomes for other glenoid types.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究评估了在原发性盂肱关节炎且为B2型或B3型肩胛盂的患者中，使用标准肩胛盂假体进行肩关节置换术改善患者自我评估的舒适度和功能，以及纠正术前肱骨头在肩胛盂表面偏心的能力。
我们确定了66例接受全肩关节置换术的肩胛盂，其中40例为B2型肩胛盂，26例为B3型肩胛盂，植入非增强型肩胛盂假体时未试图使肩胛盂角度正常化，临床和影像学随访至少2年。简易肩关节测试（SST）、肱骨头在肩胛盂表面的偏心百分比以及骨长入中心栓是主要关注的结局变量。对同时患有A1型、A2型、B1型和D型肩胛盂病理解剖的患者进行了类似分析，以确定B2型和B3型肩胛盂的结局是否劣于其他类型。
对于B2型肩胛盂，在平均2.8±1.2年时，SST评分（及标准差）从术前的3.2±2.1分提高到术后的9.9±2.4分（p<0.001）；对于B3型肩胛盂，在平均2.9±1.5年时，SST评分从术前的3.0±2.5分提高到术后的9.4±2.1分（p<0.001）；这些结果并不劣于其他肩胛盂类型的肩关节。术后肩胛盂角度与术前相比无显著差异（p>0.05）。B2型肩胛盂肱骨头在肩胛盂表面的平均偏心度从术前的-14%±7%降至术后的-1%±2%（p<0.001），B3型肩胛盂从术前的-4%±6%降至术后的-1%±3%（p=0.027）。B2型肩胛盂（83%）和B3型肩胛盂（81%）骨长入中心栓的比例不低于其他肩胛盂类型。
植入标准肩胛盂且不改变角度的肩关节置换术可显著改善患者舒适度和功能，并持续使B2型和B3型肩胛盂肩关节的肱骨头在肩胛盂表面居中，实现中心栓骨整合率>80%。B2型和B3型肩胛盂的这些临床和影像学结局并不劣于其他肩胛盂类型。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
