Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France.
Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece.
Orthop Traumatol Surg Res. 2022 May;108(3):103263. doi: 10.1016/j.otsr.2022.103263. Epub 2022 Mar 4.
Reverse total shoulder arthroplasty (RSA) associated with modified L'Episcopo (isolated LD) or L'Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome.
A retrospective review of 24 RSAs (mean age 68.71 years, range 52-83) associated with modified L'Episcopo procedure (9) and L'Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores.
With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34).
At short-term follow-up, RSA combined with L'Episcopo or modified l'Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\TM tendon transfer.
IV; retrospective study.
反向全肩关节置换术（RSA）联合改良 L'Episcopo（单独 LD）或 L'Episcopo（联合 TM 和 LD）手术已被证实可有效克服肩袖巨大后上撕裂和小圆肌缺失患者的预期外旋不足。本研究的目的是评估 RSA 联合肌腱转移术后外侧近端肱骨的放射学骨病变，并确定这些骨病变是否影响临床结果。
回顾性分析 24 例 RSA（平均年龄 68.71 岁，范围 52-83），其中改良 L'Episcopo 手术 9 例，L'Episcopo 手术 15 例。评估 X 线片的外侧皮质病变，并分为完整、不规则或完全溶骨性表现。此外，还评估了柄松动的迹象。临床结果测量包括活动范围、SSV、VAS 和 Constant-Murley 评分。
平均随访 44.71 个月（12-97；SD 27.42），8 例（33.3%）患者的外侧皮质完整，8 例（33.3%）不规则，8 例（33.3%）溶骨性病变。与 74%的非骨水泥柄相比，40%的骨水泥柄显示皮质变形。在 1 个骨水泥柄中检测到透光线（p=0.046）。GT 吸收（p=0.147）、骨密度增高线（p=0.449）和点焊（p=0.342）仅出现在非骨水泥柄中。术后所有患者（24 例）的所有临床和功能参数均显著改善。将有骨病变的患者（2 组，16 例）与无骨病变的患者（1 组，8 例）进行比较，发现功能评分和活动范围无显著差异：Constant（p=0.61）、VAS（p=0.61）、SSV（p=0.66）和外旋（p=0.34）。
短期随访结果显示，RSA 联合 L'Episcopo 或改良 L'Episcopo 手术会导致外侧近端肱骨病变发生率高（67%）。在骨水泥柄中发现透光线，而非骨水泥柄中出现应力遮挡和 GT 吸收的迹象。然而，未发现肱骨干松动的病例，这些病变似乎并不影响临床结果。在 RSA 联合 LD/TM 肌腱转移术中，应积极考虑使用骨水泥直柄标准长度肱骨柄。
IV；回顾性研究。
