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全肩关节置换术后骨溶解的发病机制、评估与处理

Pathogenesis, Evaluation, and Management of Osteolysis After Total Shoulder Arthroplasty.

作者信息

Kunze Kyle N, Krivicich Laura M, Brusalis Christopher, Taylor Samuel A, Gulotta Lawrence V, Dines Joshua S, Fu Michael C

机构信息

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.

Sports Medicine Institution-Shoulder and Elbow Division, Hospital for Special Surgery, New York, NY, USA.

出版信息

Clin Shoulder Elb. 2022 Sep;25(3):244-254. doi: 10.5397/cise.2021.00738. Epub 2022 Jul 5.

DOI:10.5397/cise.2021.00738
PMID:35971608
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9471816/
Abstract

Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA-namely, periprosthetic joint infection-as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.

摘要

全肩关节置换术（TSA）后影像学上的骨质溶解仍然是一个具有挑战性的临床问题，因为它最初可能不会表现出明显的临床症状，但会导致重要的临床并发症，如无菌性松动。全面考虑病史和体格检查对于排除有症状的TSA的其他原因（即假体周围关节感染）至关重要，因为由于假体组件细微松动，症状通常会发展为模糊的疼痛或不适。一旦确诊，鉴于有可能避免手术相关风险，应首先采取骨质溶解的非手术治疗。如有必要，目前的手术选择包括盂肱关节聚乙烯翻修术和转换为反向全肩关节置换术。本文通过对当前概念的循证讨论，对TSA后骨质溶解的评估和管理进行了全面综述。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e55/9471816/7f563015f8f7/cise-2021-00738f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e55/9471816/1c1ac7f05c56/cise-2021-00738f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e55/9471816/7f563015f8f7/cise-2021-00738f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e55/9471816/1c1ac7f05c56/cise-2021-00738f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e55/9471816/7f563015f8f7/cise-2021-00738f2.jpg

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