Berton Alessandra, Gulotta Lawrence V, Longo Umile Giuseppe, De Salvatore Sergio, Piergentili Ilaria, Bandini Benedetta, Lalli Alberto, Mathew Joshua, Warren Russell F, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy.
Centro Integrato di Ricerca (CIR), Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
J Clin Med. 2021 Dec 14;10(24):5868. doi: 10.3390/jcm10245868.
One of the original biomechanical principles of reverse total shoulder arthroplasty (RTSA) is medialization of the center of rotation (COR) relative to the native level of the glenoid. Several authors have proposed the lateralized center of rotation, which is characterized by a lateralized (L) glenoid and medialized (M) humeral component. The aim of this review is to compare the clinical and functional outcomes of COR in medialized (M-RTSA) and lateralized (L-RTSA) RTSA in patients with uniform indications and treatment through a meta-analysis. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Clinical Answers was conducted from April to May 2021. Twenty-four studies were included in the qualitative synthesis, and 19 studies were included in the meta-analysis. Treatment with RTSA resulted in positive post-operative outcomes and low complication rates for both groups. Statistically relevant differences between L-RTSA group and M-RTSA group were found in post-operative improvement in external rotation with arm-at-side (20.4° and 8.3°, respectively), scapular notching rates (6.6% and 47.7%) and post-operative infection rates (1% and 7.7%). Both lateralized and medialized designs were shown to improve the postoperative outcomes. Nevertheless, a lateralized COR resulted in greater post-operative external rotation.
反式全肩关节置换术（RTSA）最初的生物力学原理之一是旋转中心（COR）相对于关节盂原始水平的内移。几位作者提出了外移旋转中心，其特征是关节盂外移（L）和肱骨头组件内移（M）。本综述的目的是通过荟萃分析比较具有统一适应症和治疗方法的患者在内移式（M-RTSA）和外移式（L-RTSA）RTSA中COR的临床和功能结果。2021年4月至5月，我们按照PRISMA指南在PubMed、Medline、Embase、Scopus、Cochrane对照试验中央登记册、Cochrane系统评价数据库和Cochrane临床答案中进行了文献检索。定性综合纳入了24项研究，荟萃分析纳入了19项研究。两组患者接受RTSA治疗后均取得了积极的术后结果，并发症发生率较低。L-RTSA组和M-RTSA组在术后手臂在体时外旋改善（分别为20.4°和8.3°）、肩胛切迹率（6.6%和47.7%）和术后感染率（1%和7.7%）方面存在统计学上的显著差异。外移式和内移式设计均显示可改善术后结果。然而，外移式COR导致术后外旋更大。
