非骨水泥型肱骨头表面置换的结果及翻修率：中期随访研究
Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study.
作者信息
Chillemi Claudio, Paglialunga Carlo, De Giorgi Greta, Proietti Riccardo, Carli Stefano, Damo Marco
机构信息
Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico, Latina 04100, Lazio, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy.
出版信息
World J Orthop. 2021 Jun 18;12(6):403-411. doi: 10.5312/wjo.v12.i6.403.
BACKGROUND
Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world's population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components.
AIM
To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis.
METHODS
This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR.
RESULTS
In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case.
CONCLUSION
HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.
背景
盂肱关节骨关节炎（OA）是疼痛和残疾的常见原因，影响着近三分之一的60岁以上世界人口。与其他关节一样，肩关节置换术似乎是最有效的治疗方法。植入物设计随着时间的推移不断演变，逐渐过渡到更短的肱骨干长度甚至无柄组件。
目的
评估一组患有OA或缺血性坏死患者的非骨水泥型肱骨头表面置换术（HHR）的中期结果和生存率。
方法
这是一项回顾性研究，对23例患者（15例女性和8例男性）前瞻性收集的数据进行了7.4年的随访，这些患者接受了HHR治疗。收集的数据包括临床和影像学评估。术前和术后记录了Constant评分、视觉模拟量表以及活动范围的临床评估。纳入了15例OA患者（2例轻度、6例中度和7例重度）和10例缺血性坏死患者（根据Cruess分类为III期）。对X线片进行评估以检测松动迹象、退行性改变和肱骨头向上移位。术前还进行了磁共振成像以评估肩袖状态。肌腱完整性是植入HHR的必要条件。
结果
共有19例患者（21个肩关节）完成了随访。4例患者的4个肩关节因假体失败而失访。总体翻修率为16%。据报道，平均Constant评分、视觉模拟量表和活动范围有统计学意义的改善。未发现松动迹象，但在12例中发现了肩胛盂侵蚀。肱骨侧出现骨赘7次，肩胛盂侧出现12次。仅1例记录到肱骨头向上移位。
结论
对于肩袖完整的OA和缺血性坏死患者，HHR仍然是一个合理的选择。
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