Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Arch Orthop Trauma Surg. 2023 Feb;143(2):699-706. doi: 10.1007/s00402-021-04125-2. Epub 2021 Aug 18.
Although age is considered to be the major risk factor of primary glenohumeral osteoarthritis (GOA), younger population may suffer from degenerative changes of the shoulder joint without evidence of any leading cause. The purpose of this study was to investigate the risk profile in young patients suffering from presumably primary GOA.
A consecutive group of 47 patients undergoing primary shoulder arthroplasty for early-onset GOA below the age of 60 years at time of surgery was retrospectively identified and prospectively evaluated. Patients with identifiable cause for GOA (secondary GOA) were excluded. The resulting 32 patients (mean age 52 ± 7 years; 17 male, 15 female) with primary GOA were matched by age (± 3 years) and gender to 32 healthy controls (mean age 53 ± 7 years; 17 male, 15 female). Demographic data and patient-related risk factors were assessed and compared among both groups to identify extrinsic risk factors for primary GOA. Patients were further subdivided into a group with concentric GOA (group A) and a group with eccentric GOA (group B) to perform a subgroup analysis.
Patients had a significantly higher BMI (p = 0.017), were more likely to be smokers (p < 0.001) and to have systematic diseases such as hypertension (p = 0.007) and polyarthritis (p < 0.001) and a higher Shoulder Activity Level (SAL) (p < 0.001) when compared to healthy controls. Furthermore, group B had a significantly higher SAL not only compared to healthy controls but also to group A, including activities such as combat sport (p = 0.048) and weightlifting (p = 0.01).
Several patient-specific risk factors are associated with primary GOA in the young population, as well as highly shoulder demanding activities in the development of eccentric GOA. Consequently, a subset of young patients with eccentric primary GOA could in reality be secondary due to a muscular imbalance between internal and external rotators caused by improper weight training.
III, Case-Control study.
尽管年龄被认为是原发性肩峰下撞击症（GOA）的主要危险因素，但年轻人群可能会出现肩关节退行性改变，而没有任何主要病因的证据。本研究的目的是探讨患有早期原发性 GOA 的年轻患者的风险特征。
回顾性地确定了一组连续的 47 名因早期原发性 GOA 而接受初次肩关节置换术的患者，这些患者在手术时的年龄均低于 60 岁。排除有明确 GOA 病因（继发性 GOA）的患者。最终纳入了 32 名原发性 GOA 患者（平均年龄 52 ± 7 岁；17 名男性，15 名女性），这些患者按年龄（± 3 岁）和性别与 32 名健康对照组（平均年龄 53 ± 7 岁；17 名男性，15 名女性）相匹配。评估并比较两组患者的人口统计学数据和与患者相关的危险因素，以确定原发性 GOA 的外在危险因素。患者进一步分为同心型 GOA 组（A 组）和偏心型 GOA 组（B 组），以进行亚组分析。
与健康对照组相比，患者的 BMI 明显更高（p = 0.017），更有可能吸烟（p < 0.001），并且患有高血压（p = 0.007）和多关节炎（p < 0.001）等系统性疾病，以及更高的肩部活动水平（SAL）（p < 0.001）。此外，B 组的 SAL 不仅明显高于健康对照组，而且高于 A 组，包括参与对抗性运动（p = 0.048）和举重（p = 0.01）等活动。
一些患者特有的危险因素与年轻人群中的原发性 GOA 以及偏心型 GOA 的发展中对肩部要求较高的活动有关。因此，一部分患有偏心原发性 GOA 的年轻患者实际上可能是继发性的，原因是内部和外部旋转肌之间的肌肉平衡因不当的举重训练而受到破坏。
III，病例对照研究。
