Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2022 Apr;31(4):736-746. doi: 10.1016/j.jse.2021.08.011. Epub 2021 Sep 17.
With the increasing use of lateralized humeral implants in reverse total shoulder arthroplasty (RTSA), it is still unclear whether this design will be as advantageous as the medialized humeral implants in the setting of pseudoparalysis (PP).
A total of 51 eligible RTSA cases for PP signs due to massive rotator cuff deficiency were selected for the retrospective review. Twenty-five patients were allocated to group L in which the isolated humeral side lateralization was performed (neck-shaft angle of 145°), and 26 patients were allocated to group M (neck-shaft angle of 155°). Pre- and postoperative radiologic measurements including critical shoulder angle, acromiohumeral distance (AHD), lateral humeral offset (LHO), and deltoid wrapping offset (DWO), as well as range of motion (ROM) and clinical outcome scores, were compared. The mean age was 71.0 ± 6.5 years for group L and 70.3 ± 7.0 years for group M, and the overall mean follow-up period was 49.0 ± 13.5 months (range, 25.7-68.9).
The preoperative radiologic measurements were similar, but the postoperative LHO and DWO were significantly larger for group L, whereas the postoperative AHD was larger for group M compared with group L, with the values being 39.8 ± 9.7 mm and 33.6 ± 10.4 mm, respectively (P = .034). For the ROM, active forward elevation did improve significantly for both, starting preoperatively with the active ranges of 39° ± 19° (passively 153° ± 24°) for group L and 42° ± 18° (passively 156° ± 11°) for group M-the final postoperative active ranges being 142° ± 16° and 133° ± 33°, respectively, without significant difference between the groups (P = .426). The postoperative recovery of PP for group L was 100% (25 of 25), whereas for group M, it was 96.2% (25 of 26). The final visual analog scale (VAS) scores and University of California Los Angeles (UCLA) shoulder scores improved significantly for both groups, but the differences between the groups at the final assessments were insignificant. The 4 complications were periprosthetic fracture, acromial stress fracture, periprosthetic joint infection, and neuropraxia, all of which were in group M, and scapular notching with higher grades were more prevalent for group M (26.9%, 7 of 26).
With RTSA, good outcomes and recovery were achieved in most cases of PP. The postoperative active elevation range and functional outcomes were not affected by medialization or lateralization of the humeral implant. Earlier recovery of motion was observed with the lateralized group, but no significant differences were seen in the final ROM between the groups.
随着外侧化肱骨假体在反式全肩关节置换术（RTSA）中的应用越来越多，在假性瘫痪（PP）的情况下，这种设计是否会像内侧化肱骨假体那样有利，目前仍不清楚。
回顾性选择了 51 例因巨大肩袖缺损而出现 PP 征象的 RTSA 患者进行研究。25 例患者被分配到 L 组（采用 145°的肱骨侧偏置），26 例患者被分配到 M 组（采用 155°的肱骨侧偏置）。比较术前和术后影像学测量指标，包括临界肩角、肩峰肱骨头间距（AHD）、外侧肱骨偏移（LHO）和三角肌包裹偏移（DWO），以及活动范围（ROM）和临床结果评分。L 组的平均年龄为 71.0±6.5 岁，M 组为 70.3±7.0 岁，总体平均随访时间为 49.0±13.5 个月（范围为 25.7-68.9）。
术前影像学测量指标相似，但 L 组术后 LHO 和 DWO 明显增大，而 M 组术后 AHD 较 L 组增大，分别为 39.8±9.7mm 和 33.6±10.4mm（P=.034）。对于 ROM，两组的主动前屈都有明显改善，术前 L 组的主动范围为 39°±19°（被动范围为 153°±24°），M 组为 42°±18°（被动范围为 156°±11°），术后最终主动范围分别为 142°±16°和 133°±33°，两组间无显著差异（P=.426）。L 组术后 PP 恢复 100%（25/25），M 组为 96.2%（25/26）。两组术后视觉模拟评分（VAS）和加州大学洛杉矶分校（UCLA）肩部评分均明显改善，但组间最终评估无显著差异。4 例并发症为假体周围骨折、肩峰应力性骨折、假体周围关节感染和神经损伤，均发生在 M 组，M 组更常见较高等级的肩胛切迹（26.9%，26 例中有 7 例）。
在 RTSA 中，大多数 PP 患者都取得了良好的疗效和恢复。肱骨假体的内侧化或外侧化并不影响术后主动活动范围和功能结果。偏置组术后运动恢复较早，但组间最终 ROM 无显著差异。
