Al Yaseen Mustafa, Smart Yat Wing, Seyed-Safi Parisah, Abdelmonem Abdelmonem H, Makki Daoud, Morgan Barnes, Sandher Dilraj
Trauma and Orthopaedics, West Hertfordshire Teaching NHS Trust, Watford, GBR.
Orthopaedic Surgery, Imperial College London, London, GBR.
Cureus. 2022 Jun 7;14(6):e25741. doi: 10.7759/cureus.25741. eCollection 2022 Jun.
Functional outcomes following reverse geometry shoulder arthroplasty can vary. This study assessed the effects of glenosphere size, humeral stem version, posterior rotator cuff status and subscapularis repair on patient-reported outcome and range of motion. Methods: A consecutive series of 132 patients from two orthopaedic centres that use the same onlay system for reverse shoulder arthroplasty were reviewed over a six-year period. Outcome measures consisted of the Oxford Shoulder score (OSS) and range of motion (ROM) at one year following surgery. These were assessed against glenosphere sizes (small (36-38 mm) and large (40-42 mm)), humeral stem retroversion (less or more than 20 degrees), rotator cuff status (posterior rotator cuff present or absent) and subscapularis tendon (repaired or not) at the end of procedure.
Larger glenospheres and less humeral stem retroversion yielded better ROM and OSS but this was not statistically significant. Subscapularis repair had no effect on outcomes. Preservation of posterior rotator cuff tendons improved functional outcomes. The number of tendons present at the end of procedure had a positive effect on outcome (best with two tendons and better with one compared to a completely bald humeral head).
Preservation of posterior rotator cuff tendons during reverse shoulder arthroplasty improves clinical outcomes unlike subscapularis repair which was found to be unnecessary. Implant size and version in reverse geometry arthroplasty have no significant effects on clinical outcome.
反式肩关节置换术后的功能结果可能各不相同。本研究评估了球盂假体尺寸、肱骨干扭转角度、后方肩袖状态和肩胛下肌修复对患者报告的结果和活动范围的影响。
对来自两个骨科中心的连续132例患者进行回顾性研究，这两个中心在六年期间都使用相同的覆盖系统进行反式肩关节置换术。结果测量指标包括术后一年的牛津肩部评分（OSS）和活动范围（ROM）。根据手术结束时的球盂假体尺寸（小（36 - 38毫米）和大（40 - 42毫米））、肱骨干后倾（小于或大于20度）、肩袖状态（存在或不存在后方肩袖）和肩胛下肌腱（修复或未修复）对这些指标进行评估。
较大的球盂假体和较小的肱骨干后倾角度可产生更好的ROM和OSS，但差异无统计学意义。肩胛下肌修复对结果无影响。保留后方肩袖肌腱可改善功能结果。手术结束时存在的肌腱数量对结果有积极影响（两根肌腱时最佳，一根肌腱时优于肱骨头完全无肌腱附着）。
与发现不必要的肩胛下肌修复不同，在反式肩关节置换术中保留后方肩袖肌腱可改善临床结果。反式肩关节置换术中的植入物尺寸和角度对临床结果无显著影响。
