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帕金森病对反式全肩关节置换术结果和并发症发生率的影响:一项配对组分析。

The Influence of Parkinson's Disease on Outcome and Complication Rate of Reverse Total Shoulder Arthroplasty: A Matched Group Analysis.

出版信息

Orthopedics. 2021 Mar-Apr;44(2):86-91. doi: 10.3928/01477447-20210217-02. Epub 2021 Mar 1.

Abstract

Parkinson's disease (PD) is associated with a higher complication rate after common orthopedic procedures, such as spinal fusion, knee arthroplasty, or hip arthroplasty. A few reports have also suggested higher complication rates after reverse total shoulder arthroplasty (RTSA). The aim of this study was to assess the outcome and complication profile of patients with RTSA and PD. A total of 17 patients (mean age, 73.9±9.5 years) with PD and RTSA with a minimum follow-up of 2 years were identified on screening of the authors' institutional RTSA database. These patients were compared with a 1:4 matched cohort group of 68 patients (mean age, 73.9±7.9 years) without PD. Complications and revisions for all patients were assessed by review of medical records. Outcome scores included the Constant-Murley score and the Subjective Shoulder Value. At a mean follow-up of 49.5±24 months, statistically significant improvements were obtained in postoperative Subjective Shoulder Value, Constant-Murley score, pain, flexion, abduction, internal rotation, and strength for both groups. However, the control group had significantly greater improvements in flexion, abduction, strength, Subjective Shoulder Value, and Constant-Murley score. Postoperative complications (35% vs 6%; odds ratio, 8.7) and reinterventions (29% vs 1%; odds ratio, 27.9) were substantially greater for patients with PD, with the most frequent complications being fractures of the scapular spine and the acromion. Reverse total shoulder arthroplasty is associated with a significantly higher complication rate and revision rate and an inferior outcome in patients with PD compared with neurologically healthy patients. Indications for RTSA should be carefully evaluated and questioned for patients with PD. [. 2021;44(2):86-91.].

摘要

帕金森病(PD)与常见骨科手术(如脊柱融合、膝关节置换或髋关节置换)后更高的并发症发生率相关。一些报告还表明,反向全肩关节置换术(RTSA)后并发症发生率更高。本研究旨在评估 RTSA 合并 PD 患者的治疗效果和并发症情况。通过筛选作者所在机构的 RTSA 数据库,共确定了 17 例(平均年龄 73.9±9.5 岁)RTSA 合并 PD 且随访至少 2 年的患者。这些患者与一组 68 例(平均年龄 73.9±7.9 岁)无 PD 的患者进行了 1:4 匹配。通过审查病历评估所有患者的并发症和翻修情况。评估所有患者的术后结果评分包括 Constant-Murley 评分和主观肩部值。在平均 49.5±24 个月的随访中,两组患者的术后主观肩部值、Constant-Murley 评分、疼痛、屈伸、外展、内旋和力量均有显著改善。然而,对照组在屈伸、外展、力量、主观肩部值和 Constant-Murley 评分方面的改善明显更大。PD 患者术后并发症(35%比 6%;比值比,8.7)和再次干预(29%比 1%;比值比,27.9)显著更高,最常见的并发症是肩胛脊柱和肩峰骨折。与神经健康患者相比,RTSA 在 PD 患者中与更高的并发症发生率和翻修率以及较差的治疗效果相关。对于 PD 患者,应仔细评估并质疑 RTSA 的适应证。[关节外科杂志,2021;44(2):86-91。]。

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