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肩袖巨大撕裂的反式全肩关节置换术:Hamada 分类法能否预测临床结果?

Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

机构信息

Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Germany.

Orthopedics and Traumatology, Clinique Générale Ste-Anne, rue Hans-Geiler 6, 1700, Fribourg, Switzerland.

出版信息

Arch Orthop Trauma Surg. 2022 Jul;142(7):1405-1411. doi: 10.1007/s00402-021-03755-w. Epub 2021 Jan 28.

Abstract

INTRODUCTION

Reverse total shoulder arthroplasty (RTSA) is a widely recognized treatment to reduce pain and improve shoulder function for patients in various disease stages of cuff tear arthropathy (CTA). However, it remains unclear whether outcomes after RTSA depend on the preoperative stage of CTA. Therefore, this study evaluated whether the Hamada classification influences midterm clinical outcomes after RTSA.

MATERIALS AND METHODS

In this multicenter observational study, patients underwent inverted bearing RTSA for massive rotator cuff tears or CTA. Shoulders were grouped into those with (Hamada grades 4a, 4b, and 5) and those without (Hamada grades 1, 2, and 3) glenohumeral arthritis. Clinical outcomes, including range of motion, Constant score, American Shoulder and Elbow Surgeons score, and visual analog scale for pain and satisfaction, were determined preoperatively and at 24 and > 30 months. All complications were recorded, and survival free from any implant component revision was calculated.

RESULTS

Overall, 202 patients (211 shoulders) were treated with RTSA at a mean age of 75.8 ± 6.6 years (range 41.9-91.6 years). Of these, 144 patients (151 shoulders) were available for a mean follow-up of 79.9 ± 24.7 months (range 30.2-132.3 months). No significant between-group differences were found for clinical outcomes at 24 and > 30 months (P > 0.05). Furthermore, the Hamada classification did not correlate with clinical outcomes at 24 (P = 0.98) and > 30 months (P = 0.29). Revision-free implant component survival was similar between groups (P = 0.17). Postoperative complications were found in 11 shoulders, of which 10 required revision.

CONCLUSIONS

Inverted bearing RTSA was found to be an effective treatment with similarly good midterm clinical outcomes, similar revision rates, and high implant survival rates in every stage of massive rotator cuff tears. Overall, the preoperative Hamada classification did not influence clinical outcomes or complications after RTSA.

摘要

简介

反向全肩关节置换术(RTSA)是一种广泛认可的治疗方法,可减轻肩袖撕裂性关节炎(CTA)各期患者的疼痛并改善肩部功能。然而,RTSA 后的结果是否取决于 CTA 的术前阶段仍不清楚。因此,本研究评估了 Hamada 分类是否会影响 RTSA 后的中期临床结果。

材料与方法

在这项多中心观察性研究中,患者因巨大肩袖撕裂或 CTA 而行反向承重型 RTSA。将肩关节分为伴有(Hamada 4a、4b 和 5 级)和不伴有(Hamada 1、2 和 3 级)肩关节炎两组。术前及术后 24 个月和>30 个月时,采用肩关节活动范围、Constant 评分、美国肩肘外科评分(ASES)和视觉模拟评分(VAS)评估疼痛和满意度等临床结果。记录所有并发症,并计算无任何植入物部件翻修的生存率。

结果

总体而言,202 例患者(211 侧)接受 RTSA 治疗,平均年龄 75.8±6.6 岁(范围 41.9-91.6 岁)。其中,144 例患者(151 侧)获得平均 79.9±24.7 个月(范围 30.2-132.3 个月)的随访。术后 24 个月和>30 个月时,两组间临床结果无显著差异(P>0.05)。此外,Hamada 分类与术后 24 个月(P=0.98)和>30 个月(P=0.29)时的临床结果无关。两组间的翻修率无显著差异(P=0.17)。11 侧出现术后并发症,其中 10 侧需要翻修。

结论

反向承重型 RTSA 是一种有效的治疗方法,在肩袖巨大撕裂的各个阶段均具有良好的中期临床效果、相似的翻修率和高的植入物存活率。总体而言,术前 Hamada 分类并不影响 RTSA 后的临床结果或并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be95/9217847/a3b741590766/402_2021_3755_Fig1_HTML.jpg

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