Shoulder and Elbow Unit. Traumatology and Orthopaedic Surgery Department, Universitat Autónoma de Barcelona, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Traumatology and Orthopaedic Surgery Department, Universidad de Barcelona, Universitary Hospital of Mutua de Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1275-1281. doi: 10.1007/s00590-022-03292-1. Epub 2022 May 24.
The aim of this study is to review our experience with the pectoralis-major-pedicled bone window for the revision of shoulder arthroplasty.
This study used the retrospective case series of six patients who underwent a pectoralis-major-pedicled bone window for revision of shoulder arthroplasty, with a minimum follow-up of 2 years. Demographic, clinical, and radiological data were analyzed.
The mean age of the included patients was 72.6 years old (standard deviation (SD) 4.7), and 83.3% were women (5/1). The mean follow-up was 36.6 months (range 25-48 months). Five patients had a shoulder hemiarthroplasty and one patient a reverse shoulder arthroplasty. The indications for revision were pain in five patients and recurrent dislocation in one patient. No intraoperative complications were found. One patient developed a wound infection that required debridement and a two-stage revision. Despite complications, 2 years after surgery, the range of motions and functional scores were improved from preoperative levels. The difference between preoperative and postoperative VAS pain scores was 7.1 points (p < 0.001). The difference between preoperative and postoperative CSS and ASES questionnaires were 32 and 31.6 points, respectively (p < 0.001). At the final follow-up, all radiographs showed bone union of the osteotomy, good fixation of all components, without evidence of prosthetic loosening or migration.
Revision of a shoulder arthroplasty using a pectoralis-major-pedicled bone window can be an effective treatment that can yield pain relief; however, improvements in motion and function were difficult to achieve.
本研究旨在回顾我们使用胸大肌蒂骨窗进行肩关节置换翻修的经验。
本研究回顾性分析了 6 例接受胸大肌蒂骨窗行肩关节置换翻修的患者，随访时间至少 2 年。分析了患者的人口统计学、临床和影像学资料。
纳入患者的平均年龄为 72.6 岁（标准差 4.7），83.3%为女性（5/1）。平均随访时间为 36.6 个月（25-48 个月）。5 例为肩关节半关节置换，1 例为反肩关节置换。翻修指征为 5 例患者疼痛，1 例患者复发性脱位。术中未发现并发症。1 例患者发生伤口感染，需要清创和二期翻修。尽管发生了并发症，但术后 2 年，患者的关节活动度和功能评分均较术前有所改善。术前与术后 VAS 疼痛评分的差异为 7.1 分（p<0.001）。术前与术后 CSS 和 ASES 问卷评分的差异分别为 32 分和 31.6 分（p<0.001）。末次随访时，所有 X 线片均显示截骨处骨愈合良好，所有假体均固定良好，无假体松动或迁移的证据。
使用胸大肌蒂骨窗进行肩关节置换翻修是一种有效的治疗方法，可以缓解疼痛，但运动和功能的改善难以实现。
