Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France.
Unité de chirurgie du membre supérieur, Centre OrthoSud, 15, avenue du Pr Grasset, 34090 Montpellier, France.
Orthop Traumatol Surg Res. 2022 May;108(3):103145. doi: 10.1016/j.otsr.2021.103145. Epub 2021 Nov 12.
Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population.
This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder.
The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change.
Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion.
IV, retrospective study.
下肢神经功能缺损患者在轮椅上反复转移和推动会对上肢造成机械性过载，尤其是肩部，成为承重部位。在这种情况下，关节置换植入物会承受很大的压力，尽管这种情况的关节置换适应证存在争议。我们假设在承重的肩部进行关节置换将减轻疼痛并改善活动范围，从而对功能和自主性产生积极影响，而不会增加相对于健全人群的并发症发生率。
这是一项回顾性研究，共涉及 11 名患者的 13 个植入物（4 例全肩关节置换术、4 例半肩关节置换术和 3 例反肩关节置换术），平均随访 33.7±27 个月（12-85 个月）。临床评估包括主动和被动活动范围、疼痛、Constant 评分和轮椅使用者肩部疼痛指数（WUSPI）。评估 X 光片以寻找松动和肩胛切迹的迹象。通过转移次数、运动方式（手动或电动轮椅）和功能独立性测量（FIM）评估患者的独立性。根据初始病理将患者分为两组：神经源性肩部或功能性肩部。
11 名患者的平均年龄为 64±19 岁（23-85 岁），均为长期轮椅使用者（电动或手动）。VAS 疼痛评分从术前 8±3 降至术后 4±2（p=0.003）。Constant 评分从术前 22±11 增加了 90%至术后 42±23（p=0.008）。WUSPI 评分从 80±30 降低 73%至 21±15（p=0.001）。在功能性肩部患者亚组中，活动范围得到改善，但在神经源性肩部患者亚组中未得到改善。5 名患者（63%）的运动方式因获得电动轮椅而发生改变，但日常转移次数没有明显变化。最终评估时没有影像学显示植入物松动的迹象。有 2 例植入物需要翻修：一例解剖型假体因继发性肩袖撕裂而改为反式配置；一例早期感染需要进行两阶段植入物更换。
承重肩部的关节置换术是肩袖撕裂性关节炎和肩肱关节炎的有效中期治疗方法，主要用于缓解疼痛，活动范围略有改善，具体取决于初始病理。这种干预需要生活方式的改变，例如日常转移习惯和运动方式的改变。
IV，回顾性研究。
