University of North Carolina, Chapel Hill, NC, USA.
Orthopaedic Associates of Central Texas, Austin, TX, USA.
J Shoulder Elbow Surg. 2022 Dec;31(12):2554-2561. doi: 10.1016/j.jse.2022.05.016. Epub 2022 Jun 22.
The primary purpose of this study was to compare 2-year anatomic total shoulder arthroplasty (TSA) functional and radiographic outcomes between Walch type A and B glenoids treated with an all-polyethylene glenoid designed for hybrid fixation with peripheral cement and central osseous integration. The secondary purpose was to evaluate outcomes based on central peg technique. The hypotheses were that there would be no difference in short-term radiographic or functional outcome scores based on preoperative glenoid morphology or central peg technique.
We performed a multicenter retrospective review of patients who underwent TSA with the same hybrid all-polyethylene glenoid and had minimum 2-year follow-up. Patient-reported outcomes and radiographic outcomes were analyzed based on preoperative Walch morphology and central peg technique. Radiographic analysis included preoperative glenoid morphology; preoperative and postoperative glenoid version, glenoid inclination, and posterior humeral head subluxation; and postoperative glenoid radiolucencies according to the Wirth and Lazarus classifications.
A total of 266 patients with a mean age of 64.9 ± 8.2 years were evaluated at a mean of 28 months postoperatively. Postoperatively, there were significant improvements in all functional outcome measures (P < .001), range-of-motion measures (forward elevation, external rotation at 0°, external rotation at 90°, internal rotation by spinal level, and internal rotation at 90°; P < .001), and strength measures (Constant, external rotation, and modified belly press; P < .001). There were no clinically meaningful differences in functional outcomes or statistically significant differences in radiographic appearance between Walch type A and B glenoids. Subgroup analysis revealed that glenoids with a cemented central peg had the worst radiographic outcomes based on Lazarus scoring.
Patients undergoing TSA with a hybrid in-line pegged glenoid have excellent clinical outcomes at short-term follow-up regardless of preoperative glenoid morphology. Different central peg techniques do not appear to play a significant role in the risk of glenoid component lucencies at 2 years postoperatively.
本研究的主要目的是比较使用专为混合固定设计的全聚乙烯盂肱关节，治疗 Walch A 型和 B 型肩胛盂，术后 2 年的解剖全肩关节置换术（TSA）的功能和影像学结果。次要目的是基于中央钉技术评估结果。假设基于术前盂肱关节形态或中央钉技术，影像学和功能评分结果无差异。
我们对接受同种混合全聚乙烯盂肱关节置换术的患者进行了多中心回顾性研究，这些患者有至少 2 年的随访。基于术前 Walch 形态和中央钉技术分析患者报告的结果和影像学结果。影像学分析包括术前盂肱关节形态；术前和术后盂肱关节倾斜度、盂肱关节后倾和肱骨头后脱位；Wirth 和 Lazarus 分类的术后盂肱关节透亮线。
共 266 例患者平均年龄为 64.9±8.2 岁，术后平均随访 28 个月。所有功能测量值（P<.001）、活动范围测量值（前屈、0°外展、90°外展、脊柱节段内旋和 90°内旋；P<.001）和力量测量值（Constant、外旋和改良腹壁按压；P<.001）术后均有显著改善。A 型和 B 型肩胛盂的功能结果或影像学外观无临床意义差异。亚组分析显示，基于 Lazarus 评分，中央钉固定的盂肱关节的影像学结果最差。
接受混合直线钉固定全聚乙烯盂肱关节置换术的患者在短期随访中临床结果良好，无论术前盂肱关节形态如何。不同的中央钉技术在术后 2 年的盂肱关节假体透亮线风险中似乎没有显著作用。
