Kwapisz Adam, Rogers Jason P, Thigpen Charles A, Shanley Ellen, Newton Eric, Adams Kyle J, Alexander Ryan, Hawkins Richard J, Kissenberth Michael J, Tokish John M, Pill Stephan G
Hawkins Foundation, Greenville, SC, USA.
Clinic of Orthopaedics and Pediatric Orthopedics, Medical University of Łódź, Łódź, Poland.
JSES Int. 2020 Dec 5;5(1):109-113. doi: 10.1016/j.jseint.2020.09.019. eCollection 2021 Jan.
Previous studies show that reverse shoulder arthroplasty (RSA) may improve forward elevation (FE) but external rotation may remain impaired with substantial teres minor fatty infiltration. The purpose of this study was to examine the influence of fatty infiltration on postoperative range of motion (ROM) and patient-reported outcomes (PROs) after RSA with a more lateralized center of rotation.
About 69 patients (average age 69 years; 44 women, 25 men) with preoperative MRI, 1-year postoperative ROM, 2-year Veteran's Rand Survey, American Shoulder and Elbow Surgeons subjective form, and Single Alpha-Numeric Evaluation scores who underwent RSA with a lateralized glenoid component between 2010 and 2014 were identified. Patients with Fuchs stage 3 fatty degeneration were compared with patients with Fuchs stage ≤ 2 using a one-way ANOVA.
Eleven patients had Fuchs stage 3 in the teres minor and 28 with stage 3 in the infraspinatus. Charlson comorbidity indices, Veteran's Rand Survey scores, age, and BMI were not different between groups. There were no differences after one year (follow-up = 15 ± 14 months) in FE (FE = 128 ± 29) or external rotation (33 ± 13) between groups. There were no differences in two-year minimum (follow-up = 42.9 ± 17.9 months) American Shoulder and Elbow Surgeons scores between degenerated teres minor (76.4 ± 20) or infraspinatus (69.1 ± 24) groups.
This is the first study to assess the influence of teres minor and infraspinatus fatty infiltration on the postoperative ROM and PROs with a more lateralized glenoid RSA implant. Our results show that in a more lateralized RSA, neither teres minor nor infraspinatus fatty infiltration appear to negatively influence ROM or PROs.
既往研究表明，反肩关节置换术（RSA）可改善前屈（FE），但随着小圆肌大量脂肪浸润，外旋功能可能仍会受损。本研究的目的是探讨在旋转中心更偏外侧的RSA术后，脂肪浸润对活动范围（ROM）和患者报告结局（PROs）的影响。
确定了约69例患者（平均年龄69岁；44例女性，25例男性），这些患者在2010年至2014年间接受了带偏外侧肩胛盂组件的RSA手术，术前有MRI检查，术后1年有ROM数据，术后2年有退伍军人兰德调查问卷、美国肩肘外科医师主观量表及单字母数字评估评分。采用单因素方差分析，将小圆肌Fuchs 3期脂肪变性患者与Fuchs≤2期患者进行比较。
11例患者小圆肌为Fuchs 3期，28例患者冈下肌为Fuchs 3期。两组间的Charlson合并症指数、退伍军人兰德调查问卷评分、年龄和BMI无差异。两组在1年后（随访=15±14个月）的FE（FE=128±29）或外旋（33±13）方面无差异。在2年最小值时（随访=42.9±17.9个月），小圆肌（76.4±20）或冈下肌（69.1±24）退变组的美国肩肘外科医师评分无差异。
这是第一项评估更偏外侧肩胛盂RSA植入术后，小圆肌和冈下肌脂肪浸润对ROM和PROs影响的研究。我们的结果表明，在更偏外侧的RSA中，小圆肌和冈下肌脂肪浸润似乎均不会对ROM或PROs产生负面影响。
