Imai Shinji
Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan.
JB JS Open Access. 2021 Feb 24;6(1). doi: 10.2106/JBJS.OA.20.00136. eCollection 2021 Jan-Mar.
Reverse shoulder arthroplasty (RSA) is a recognized therapeutic modality for a massive rotator cuff tear. Some authors recommend lateralization of the center of rotation by bony increased offset (BIO) of the glenoid for improvement of external rotation, while others refute its effects. RSA through the conventional deltopectoral approach sacrifices the subscapularis tendon during the approach. We hypothesized that a lateral approach (LA) for RSA, with less soft-tissue resection, would restore external rotation by allowing retensioning of the remaining rotator cuff with use of a BIO graft.
We retrospectively investigated 36 nonlateralized inlay RSAs performed through a lateral approach (LA non-BIO group) and 40 inlay RSAs performed through a lateral approach with BIO (LA BIO group) for a massive rotator cuff tear. There were 5 patients with a combined loss of active elevation and external rotation (CLEER) in the LA non-BIO group and 6 in the LA BIO group. The Constant score, the UCLA (University of California Los Angeles) score, and range of motion, in particular, external rotation with the arm at 0° (ER0) and at 90° of abduction (ER90), were compared.
The mean ER90 in the LA BIO group improved significantly, from 45.8° ± 21.6° to 65.9° ± 15.8° (p = 0.012). Postoperative ER90 in the LA BIO group was significantly higher than in the LA non-BIO group (mean, 65.9° ± 15.8° compared with 53.0° ± 12.3°; p = 0.026). The mean ER0 for the patients with CLEER status significantly improved in the LA BIO group, from -15.8° ± 9.8° to 11.0° ± 15.6° (p = 0.0072). The mean postoperative anterior elevation, UCLA score, and Constant score in the LA BIO group and the LA non-BIO group improved significantly, but there was no difference between the 2 groups (anterior elevation: 131.5° ± 17.6° compared with 121.5° ± 14.1°, p = 0.07; UCLA: 25.5 ± 6.4 compared with 23.4 ± 5.4, p = 0.2; Constant: 74.3 ± 12.0 compared with 73.6 ± 10.1, p = 0.43).
LA BIO-RSA was associated with a significant improvement in range of motion, particularly external rotation. Improvements in anterior elevation, the Constant score, and the UCLA score were not significantly different from those noted for LA non-BIO-RSA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
反肩关节置换术（RSA）是治疗巨大肩袖撕裂的一种公认的治疗方式。一些作者建议通过增加肩胛盂的骨偏移（BIO）使旋转中心外移，以改善外旋功能，而另一些人则反驳其效果。通过传统的三角肌胸大肌入路进行RSA时，在手术入路过程中会牺牲肩胛下肌腱。我们假设，对于RSA采用外侧入路（LA），软组织切除较少，通过使用BIO移植物对剩余肩袖进行重新张紧，将恢复外旋功能。
我们回顾性研究了36例通过外侧入路进行的非外侧镶嵌式RSA（LA非BIO组）和40例通过外侧入路并采用BIO的镶嵌式RSA（LA BIO组）治疗巨大肩袖撕裂的病例。LA非BIO组有5例患者存在主动抬高和外旋联合丧失（CLEER），LA BIO组有6例。比较了Constant评分、加州大学洛杉矶分校（UCLA）评分以及活动范围，特别是手臂在0°（ER0）和外展90°（ER90）时的外旋情况。
LA BIO组的平均ER90显著改善，从45.8°±21.6°提高到65.9°±15.8°（p = 0.012）。LA BIO组术后的ER90显著高于LA非BIO组（平均为65.9°±15.8°，而LA非BIO组为53.0°±12.3°；p = 0.026）。LA BIO组中CLEER状态患者的平均ER0显著改善，从 -15.8°±9.8°提高到11.0°±15.6°（p = 0.0072）。LA BIO组和LA非BIO组术后的平均前屈抬高、UCLA评分和Constant评分均显著改善，但两组之间无差异（前屈抬高：131.5°±17.6°与121.5°±14.1°，p = 0.07；UCLA：25.5±6.4与23.4±5.4，p = 0.2；Constant：74.3±12.0与73.6±10.1，p = 0.43）。
LA BIO - RSA与活动范围显著改善相关，尤其是外旋功能。前屈抬高、Constant评分和UCLA评分的改善与LA非BIO - RSA相比无显著差异。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
