Georgoulas Paraskevas, Fiska Aliki, Ververidis Athanasios, Drosos Georgios I, Perikleous Evanthia, Tilkeridis Konstantinos
Department of Orthopedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
Department of Anatomy, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
Front Surg. 2021 Nov 18;8:721054. doi: 10.3389/fsurg.2021.721054. eCollection 2021.
Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.
反肩关节置换术（RSA）已成为多种骨科疾病的最佳治疗方法，如肩袖撕裂性关节病、假性麻痹、骨折后遗症、急性骨折、关节置换失败、骨关节炎和类风湿性关节炎，并且与局部疼痛缓解和功能恢复有关。目前，RSA通过前上方（AS）或三角肌胸大肌（DP）入路进行。本研究的目的是讨论这两种入路，并广泛研究它们的特点，以便在临床疗效方面进行比较。在PubMed、EMBASE和谷歌学术数据库中进行了电子检索，使用了以下关键词的组合：RSA、DP入路、AS入路、切迹和肩袖撕裂性关节病。共找到61项研究，最终纳入16篇相关文章。目前发表的文献尚未显示出因入路偏好而导致的临床过程有显著差异；DP入路的不稳定风险似乎更大，而关于肩胛切迹和骨折发生率的研究结果存在矛盾。此外，AS入路与肩峰和肩胛冈骨折风险降低有关。总之，在肩袖撕裂性关节病中，两种手术入路在疼痛和恢复活动范围（ROM）方面均显示出相似的临床结果和有效性。未来，需要基于大规模精心设计的研究进行进一步调查，以填补临床空白，从而对两种入路进行深入比较。
