From the Department of Orthopaedic Surgery, University of Florida, Gainesville, FL (Reintgen, Armington, Patrick, King, Wright), Hôpital Ambroise Paré-Hôpitaux universitaires Paris Ile-de-France Ouest (Vigan), Institut Parisien De L'Epaule (Werthel), and Department of Orthopaedic Surgery, Mayo Clinic Jacksonville, Jacksonville, FL (Schoch).
J Am Acad Orthop Surg. 2021 Oct 1;29(19):840-847. doi: 10.5435/JAAOS-D-20-01368.
Patient dissatisfaction after primary reverse total shoulder arthroplasty (rTSA) has been reported as high as 9%. In patients with excessive thoracic kyphosis, the scapula protracts and tilts anteriorly, which may lead to early impingement with the acromion and loss of forward elevation. The primary purpose of this study was to evaluate the effect of thoracic kyphosis on overhead ROM after rTSA.
A prospectively collected shoulder registry was retrospectively reviewed for all patients undergoing primary rTSA with a minimum of 2-year follow-up. Preoperative and latest follow-up ROM (forward elevation, abduction, internal rotation, and external rotation), patient-reported outcome measures (SPADI, SST-12, ASES, UCLA, SF-12, and the visual analog scale), and the Constant score were collected. Postoperative radiographs were evaluated for implant loosening and notching. Patients were separated into three groups according to the thoracic kyphosis angle (<25°, 25 to 45°, and >45°) and also analyzed as a continuous variable. The groups were compared using analysis of variance and chi-square tests as indicated.
Three hundred five shoulders in 279 patients were reviewed at a mean follow-up of 3.9 years (range 2 to 10 years). Female patients and patients with a history of heart disease were statistically more likely to have increased thoracic kyphosis (P < 0.05). After surgery, forward elevation and abduction were similar among all groups (<25: 133°, 25 to 45: 132°, >45: 127°; P = 0.199 and <25: 123°, 25 to 45: 122°, >45: 117°; P = 0.330). All other postoperative ROM measurements and all patient-reported outcome measures were also similar, regardless of measured kyphosis. In addition, no association was observed between the degree of thoracic kyphosis and scapular notching (P = 0.291).
Despite thoracic kyphosis being a known risk factor for loss of overhead motion in the native shoulder, shoulders with excessive thoracic kyphosis demonstrated similar overhead ROM at early follow-up after primary rTSA.
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初次反式全肩关节置换术（rTSA）后患者满意度低的情况高达 9%。在患有严重胸椎后凸的患者中，肩胛骨向前突出和倾斜，这可能导致早期与肩峰撞击和前向抬高丧失。本研究的主要目的是评估胸椎后凸对 rTSA 后过顶活动度的影响。
对所有接受初次 rTSA 治疗并至少随访 2 年的患者进行前瞻性收集的肩部登记处进行回顾性研究。收集术前和最新随访时的活动度（前屈、外展、内旋和外旋）、患者报告的结果测量（SPADI、SST-12、ASES、UCLA、SF-12 和视觉模拟量表）和 Constant 评分。术后 X 线片评估假体松动和切迹。根据胸椎后凸角度（<25°、25-45°和>45°）将患者分为三组，并作为连续变量进行分析。使用方差分析和卡方检验进行组间比较。
对 279 名患者的 305 个肩部进行了 3.9 年的平均随访（2-10 年）。女性患者和患有心脏病史的患者更有可能存在胸椎后凸增加（P<0.05）。手术后，所有组的前屈和外展相似（<25°：133°，25-45°：132°，>45°：127°；P=0.199 和 <25°：123°，25-45°：122°，>45°：117°；P=0.330）。所有其他术后活动度测量和所有患者报告的结果测量也相似，与测量的后凸无关。此外，胸椎后凸程度与肩胛骨切迹之间没有观察到相关性（P=0.291）。
尽管胸椎后凸是原发性全肩关节置换术后过顶运动丧失的已知危险因素，但在初次 rTSA 后早期随访时，患有严重胸椎后凸的肩部仍表现出相似的过顶活动度。
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