Patel Akshar V, Matijakovich Douglas J, Brochin Robert L, Zastrow Ryley K, Parsons Bradford O, Flatow Evan L, Hausman Michael R, Cagle Paul J
Mount Sinai Health System, New York, NY, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Shoulder Elbow. 2022 Jun;14(3):286-294. doi: 10.1177/1758573221996349. Epub 2021 Mar 8.
Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag.
We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's -test and proportions using the Chi-square test.
Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2-87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0-14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (-7 ± 21.3° to 38 ± 15.8°; value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; value = 0.17) and internal rotation (T12 to L2; value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft.
In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low. IV; Case series.
反式全肩关节置换术是治疗肩袖关节病且先前肩袖修复失败患者的常用方法。对于术前存在外旋功能障碍的患者，可在进行反式全肩关节置换术的同时行背阔肌转移术。目前的文献有限，有几项研究显示短期随访时功能和疼痛有所改善；然而，关于中期结果的数据存在不足。本研究的目的是评估中期随访时行背阔肌转移术的反式全肩关节置换术后的临床和影像学结果。我们假设术前存在外旋滞后的患者外旋和肩部功能会有显著改善。
我们回顾性分析了接受背阔肌转移术的反式全肩关节置换术患者。评估术前和术后的活动范围变化。采用美国肩肘外科医生评分和简单肩部试验评估肩部功能变化，同时使用视觉模拟量表（VAS）评估疼痛评分。复查X线片以评估肩袖关节病、脂肪浸润、肩胛切迹、基板松动和骨溶解情况。我们分别报告分类变量和连续变量的频率及均值±标准差。采用配对t检验比较均值，采用卡方检验比较比例。
15例患者符合纳入标准。该队列的平均年龄为71.7±8.4岁（范围51.2 - 87.8岁），平均随访时间为6.3±4.1年（范围1.0 - 14.5年）。行背阔肌转移术的反式全肩关节置换术改善了外旋功能（从-7±21.3°至38±15.8°；P值 = 0.001）。前屈（从116.3±45.4°至133.7±14.7°；P值 = 0.17）和内旋（T12至L2；P值 = 0.57）方面无统计学显著差异。该手术使美国肩肘外科医生评分增加（从37±19至62±22；P = 0.005），简单肩部试验评分增加（从2±2至6±3；P值 = 0.
