Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson University Hospital, Philadelphia, PA, USA; Department of Shoulder/Elbow Surgery, The Rothman Institute-Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7S):S123-S130. doi: 10.1016/j.jse.2020.12.010. Epub 2021 Jan 30.
Glenoid deformity is commonly encountered in patients undergoing reverse shoulder arthroplasty (RSA). Augmented baseplates can correct glenoid deformity while potentially avoiding certain complications encountered with structural bone graft. Limited evidence exists to support the use of metallic augmented baseplates in RSA.
We performed a retrospective review to identify all patients treated with an augmented baseplate during primary RSA with a minimum of 1 year of clinical and radiographic follow-up. Preoperative radiographs and advanced imaging were used to determine glenoid morphology and deformity. Postoperative radiographs were used to evaluate for deformity correction, radiographic complications, and early baseplate loosening or failure. Prospectively collected clinical data and patient-reported outcome scores were determined.
Primary RSA was performed with an augmented baseplate in 44 patients (mean age, 72 ± 6 years; 15 half-wedge and 29 full-wedge augmentations). Glenoid retroversion was significantly improved for the entire cohort (P = .001). Among the 22 patients with either Walch type B2, B3, or C glenoid morphology, glenoid version improved from 28° ± 8° to 16° ± 8° (P = .001). Glenoid inclination, as determined by the β angle, was significantly improved for the entire cohort (P < .001). Among the 18 patients with Favard type E2 or E3 glenoid morphology, glenoid inclination improved from 67° ± 7° to 81° ± 8° (P < .001). Postoperative range of motion and functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale score for pain significantly improved within the entire cohort (P < .05). No patients had evidence of baseplate loosening or failure of the glenoid component. Acromial stress fractures developed in 5 patients (11.4%), and 2 patients (4.5%) underwent a reoperation unrelated to the glenoid component.
Primary RSA with an augmented baseplate results in excellent short-term clinical outcomes and significant deformity correction in patients with advanced glenoid deformity. There were no complications related to the augmented baseplate or glenoid component. The rate of acromial stress fractures appears higher than typically reported and warrants further investigation.
在进行反肩关节置换术（RSA）时，经常会遇到肩胛盂畸形。增强型底盘可矫正肩胛盂畸形，同时避免结构性骨移植所带来的某些并发症。目前仅有有限的证据支持在 RSA 中使用金属增强底盘。
我们进行了一项回顾性研究，以确定所有在初次 RSA 中使用增强型底盘治疗且至少有 1 年临床和影像学随访的患者。术前 X 线片和高级影像学用于确定肩胛盂形态和畸形。术后 X 线片用于评估畸形矫正、影像学并发症以及早期底盘松动或失效。前瞻性收集临床数据和患者报告的结果评分。
44 例患者（平均年龄 72±6 岁；15 例半楔形和 29 例全楔形增强）接受了 RSA 联合增强型底盘治疗。整个队列的肩胛盂后倾均显著改善（P=0.001）。在 22 例肩胛盂形态为 Walch 类型 B2、B3 或 C 的患者中，肩胛盂倾斜角从 28°±8°改善至 16°±8°（P=0.001）。整个队列的肩胛盂倾斜角（β角）显著改善（P＜0.001）。在 18 例肩胛盂形态为 Favard 类型 E2 或 E3 的患者中，肩胛盂倾斜角从 67°±7°改善至 81°±8°（P＜0.001）。整个队列的术后活动范围和功能结果评分，包括美国肩肘外科医师评分、简易肩部测试评分、单项评估数字评估评分和疼痛视觉模拟评分均显著改善（P＜0.05）。所有患者均未出现底盘松动或肩胛盂组件失效的证据。5 例（11.4%）患者发生肩峰应力骨折，2 例（4.5%）患者因与肩胛盂组件无关的手术而再次手术。
在有严重肩胛盂畸形的患者中，初次 RSA 联合增强型底盘可获得极好的短期临床结果和显著的畸形矫正。增强型底盘或肩胛盂组件无相关并发症。肩峰应力骨折的发生率似乎高于通常报道的水平，需要进一步研究。
