用于盂生物表面重建的异体骨软骨盂移植出现不可接受的失败情况。
Unacceptable failure of osteochondral glenoid allograft for biologic resurfacing of the glenoid.
作者信息
Familiari Filippo, Hochreiter Bettina, Gerber Christian
机构信息
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Catanzaro, Italy.
出版信息
J Exp Orthop. 2021 Dec 2;8(1):111. doi: 10.1186/s40634-021-00419-x.
PURPOSE
Glenohumeral osteoarthritis (OA) represents a challenging problem in young, physically active patients. It was the purpose of this investigation to evaluate the results of a pilot study involving glenoid resurfacing with a glenoid allograft combined with a hemiarthroplasty on the humeral side.
METHODS
Between April 2011 to November 2013, 5 patients (3 men, 2 women, mean age 46.4, range 35-57) with advanced OA of the glenohumeral joint, were treated with a humeral head replacement combined with replacement of the glenoid surface with an osteochondral, glenoid allograft.
RESULTS
Overall, clinically, there was one excellent, one satisfactory and three poor results. Mean preoperative subjective shoulder value (SSV) was 34% (range: 20-50%) and preoperative relative Constant-Murley-Score (CSr) was 43 points (range: 29-64 points). Three patients with poor results had to be revised within the first three years. Their mean pre-revision SSV and CSr were 38% (range: 15-80%) and 36 points (range: 7-59 points) respectively. One patient was revised 9 years after the primary procedure with advanced glenoid erosion and pain and one patient has an ongoing satisfactory outcome without revision. Their SSVs were 60% and 83%, their CSr were 65 points and 91 points, 9 and 10 years after the primary procedure, respectively. Mean follow-up was 7 years (2-10 years) and mean time to revision was 4 years (range: 1-9 years).
CONCLUSION
The in-vivo pilot study of a previously established in-vitro technique of osteochondral glenoid allograft combined with humeral HA led to three early failures and only one really satisfactory clinical outcome which, however, was associated with advanced glenoid erosion. Osteochondral allograft glenoid resurfacing was associated with an unacceptable early failure rate and no results superior to those widely documented for HA or TSA, so that the procedure has been abandoned.
LEVEL OF EVIDENCE
Level IV, Case Series, Treatment Study.
目的
盂肱关节骨关节炎（OA）在年轻、身体活跃的患者中是一个具有挑战性的问题。本研究的目的是评估一项初步研究的结果，该研究涉及使用同种异体肩胛盂表面置换联合肱骨侧半关节置换术。
方法
2011年4月至2013年11月期间，对5例（3例男性，2例女性，平均年龄46.4岁，范围35 - 57岁）盂肱关节晚期OA患者进行了肱骨头置换术，并使用骨软骨同种异体肩胛盂置换肩胛盂表面。
结果
总体而言，临床上，1例结果优秀，1例满意，3例结果不佳。术前平均主观肩关节评分（SSV）为34%（范围：20 - 50%），术前相对Constant - Murley评分（CSr）为43分（范围：29 - 64分）。3例结果不佳的患者在头三年内需要进行翻修。他们翻修前的平均SSV和CSr分别为38%（范围：15 - 80%）和36分（范围：7 - 59分）。1例患者在初次手术后9年因肩胛盂严重侵蚀和疼痛进行了翻修，1例患者目前结果满意，未进行翻修。初次手术后9年和10年，他们的SSV分别为60%和83%，CSr分别为65分和91分。平均随访时间为7年（2 - 10年），平均翻修时间为4年（范围：1 - 9年）。
结论
先前建立的骨软骨同种异体肩胛盂联合肱骨半关节置换术的体外技术的体内初步研究导致了3例早期失败，只有1例真正令人满意的临床结果，然而，这与肩胛盂的严重侵蚀有关。骨软骨同种异体肩胛盂表面置换术的早期失败率不可接受，且没有比广泛记录的半关节置换术（HA）或全肩关节置换术（TSA）更好的结果，因此该手术已被放弃。
证据水平
IV级，病例系列，治疗研究。
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