解剖型全肩关节置换术中台阶式增强型肩胛盂假体治疗 B2 和 B3 肩胛盂病变：一项早期结果研究。
Stepped Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for B2 and B3 Glenoid Pathology: A Study of Early Outcomes.
机构信息
Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
J Bone Joint Surg Am. 2021 Oct 6;103(19):1798-1806. doi: 10.2106/JBJS.20.01420.
BACKGROUND
Posterior glenoid bone loss is commonly associated with primary glenohumeral osteoarthritis. Surgical management of bone loss in anatomic total shoulder arthroplasty (aTSA) remains controversial. We studied the use of a stepped augmented glenoid component for management of Walch B2 and B3 glenoids and compared the radiographic and clinical outcomes at short-term follow-up with those achieved with a non-augmented component of the same design in Walch A1 glenoids.
METHODS
Ninety-two patients (42 A1, 29 B2, and 21 B3 glenoids) were prospectively followed after aTSA. Sequential 3-dimensional (3D) computed tomography (CT) imaging was performed preoperatively, within 3 months postoperatively with metal artifact reduction (MAR) to define implant position, and at a minimum of 2 years postoperatively with MAR. Scapular 3D registration with implant registration allowed 3D measurement of glenoid implant position, implant shift, and central peg osteolysis (CPO).
RESULTS
CPO with or without implant shift occurred in a higher percentage of B3 glenoids treated with the augmented glenoid component (29%) than A1 glenoids treated with a standard component (5%) (p = 0.028). There was no significant difference in the frequency of CPO between B2 glenoids with the augmented component (10%) and A1 glenoids with the standard component. There was no difference in postoperative glenoid component version and inclination between groups. B3 glenoids were associated with more component medialization relative to the premorbid joint line compared with A1 and B2 glenoids (p < 0.001).
CONCLUSIONS
A stepped augmented glenoid component can restore premorbid glenoid anatomy in patients with asymmetric biconcave glenoid bone loss (Walch B2), with short-term clinical and radiographic results equivalent to those for patients without glenoid bone loss (Walch A1) treated with a non-augmented component. There is a greater risk of CPO in patients with moderate-to-severe B3 glenoid pathology with this stepped augmented glenoid component. Longer follow-up will help define the clinical implications of CPO over time.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
后盂肱骨缺失通常与原发性肩盂肱关节炎有关。在解剖型全肩关节置换术中（aTSA），对骨缺失的手术处理仍存在争议。我们研究了一种阶梯式增强型盂肱关节假体用于治疗 Walch B2 和 B3 型盂肱关节，并比较了短期随访时采用相同设计的非增强型假体治疗 Walch A1 型盂肱关节的影像学和临床结果。
方法
92 例患者（42 例 A1 型，29 例 B2 型和 21 例 B3 型盂肱关节）前瞻性随访 aTSA 后情况。术前、术后 3 个月内（采用金属伪影减少技术 [MAR] 定义假体位置）和术后至少 2 年（采用 MAR）进行连续的三维（3D）计算机断层扫描（CT）成像。肩胛骨 3D 配准与植入物配准相结合，允许对盂肱关节假体位置、假体移位和中央钉骨溶解（CPO）进行 3D 测量。
结果
在接受增强型盂肱关节假体治疗的 B3 型盂肱关节中，CPO 伴或不伴假体移位的发生率（29%）明显高于接受标准型假体治疗的 A1 型盂肱关节（5%）（p = 0.028）。在接受增强型假体治疗的 B2 型盂肱关节和接受标准型假体治疗的 A1 型盂肱关节中，CPO 的发生率无显著差异。术后两组盂肱关节假体的位置和倾斜度无差异。与 A1 型和 B2 型盂肱关节相比，B3 型盂肱关节的假体向内侧移位更明显，相对于术前关节线（p < 0.001）。
结论
在具有非对称双凹性骨缺失（Walch B2）的患者中，阶梯式增强型盂肱关节假体可恢复术前盂肱关节解剖结构，短期临床和影像学结果与无盂肱关节骨缺失（Walch A1）的患者接受非增强型假体治疗的结果相当。在使用这种阶梯式增强型盂肱关节假体时，中度至重度 B3 型盂肱关节病变患者发生 CPO 的风险更高。随着时间的推移，更长时间的随访将有助于确定 CPO 的临床意义。
证据等级
治疗性 II 级。请参阅作者指南，以获取完整的证据等级描述。
Zotero 插件