Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
J Shoulder Elbow Surg. 2023 Jul;32(7):1486-1493. doi: 10.1016/j.jse.2022.12.014. Epub 2023 Jan 20.
The most common complication with reverse shoulder arthroplasty Grammont based design with a 155° neck shaft angle (NSA) is scapular notching. Scapular notching has been associated with reduced clinical outcomes. Reducing the humeral NSA from 155° has been shown to reduce the incidence of scapular notching however it is unknown whether there is a difference in scapular notching between a 145° and 135° NSA. The purpose of this study was to evaluate the effect of decreasing the NSA on scapular notching rate and postoperative range of motion comparing 145° and 135° NSA stems at minimum 2 yr of follow-up.
Consecutive patients undergoing primary reverse shoulder arthroplasty with a NSA of either 145° or 135° between January 2014 and February 2019 were retrospectively reviewed. Patients were included if they were over the age of 18, had minimum clinical follow-up of 24 mo with true postoperative anteroposterior radiographic view.
One hundred and three patients were included for the final analysis: 73 with a 145° NSA and 30 with a 135° NSA stem. The mean age and mean follow-up were respectively 70.9 yr (range, 52.0-89.0) and 32.1 mo. The overall incidence of scapular notching was 46.6 %. There was a statistically significant difference in scapular notching between the 145° (53.4%) and 135° (30%) NSA groups (P = .028). There was no difference in terms of postoperative Constant-Murley Score (mean, 66.1 vs. 68.2; P = .395), Subjective Shoulder Value (mean, 76.5 vs. 83.1%, P = .167), forward flexion (mean, 140° vs. 142°, P = .704), abduction (mean, 123.2° vs. 121.5°, P = .771), external rotation with the arm at the side (mean, 34.1° vs. 37.3°, P = .341) and internal rotation (mean, 5.3 vs. 5.4 pts P = .336) between the 2 groups.
This is the first study to compare the effect of a 145° vs. 135° NSA on scapular notching rates. The key finding of this study is that scapular notching rate was significantly reduced from 53% to 30% in 135° NSA compared to 145° NSA, after at least 24 mo of follow-up. Our data also show that glenoid lateralization and inferiorization has an influence on scapular notching. We are unable to state that the reduced scapular notching rate was due to a reduction in NSA alone. Despite a lower rate of scapular notching, the 135° NSA group has not shown any significant better clinical and functional outcomes.
基于 Grammont 设计的反向肩关节置换术 155°颈干角（NSA）最常见的并发症是肩胛切迹。肩胛切迹与临床结果降低有关。降低 NSA 从 155°已经被证明可以降低肩胛切迹的发生率，但尚不清楚 NSA 从 145°降低到 135°是否会导致肩胛切迹发生率的差异。本研究的目的是评估降低 NSA 对肩胛切迹发生率的影响，并比较 NSA 为 145°和 135°的术后活动范围，至少随访 2 年。
回顾性分析 2014 年 1 月至 2019 年 2 月期间接受 NSA 为 145°或 135°的原发性反向肩关节置换术的连续患者。如果患者年龄超过 18 岁，术后至少有 24 个月的临床随访，且有真正的术后前后位 X 线片，则将患者纳入研究。
最终分析了 103 例患者：73 例 NSA 为 145°，30 例 NSA 为 135°。平均年龄和平均随访时间分别为 70.9 岁（范围 52.0-89.0）和 32.1 个月。肩胛切迹的总体发生率为 46.6%。在 NSA 为 145°（53.4%）和 135°（30%）的组之间，肩胛切迹的发生率存在统计学显著差异（P=0.028）。在术后Constant-Murley 评分（平均 66.1 与 68.2；P=0.395）、主观肩部值（平均 76.5 与 83.1%；P=0.167）、前屈（平均 140°与 142°；P=0.704）、外展（平均 123.2°与 121.5°；P=0.771）、外展时手臂在侧位的外旋（平均 34.1°与 37.3°；P=0.341）和内旋（平均 5.3 与 5.4 分；P=0.336）方面，两组之间没有差异。
这是第一项比较 NSA 为 145°与 135°对肩胛切迹发生率影响的研究。本研究的主要发现是，与 NSA 为 145°相比，至少随访 24 个月后，NSA 为 135°的肩胛切迹发生率从 53%显著降低至 30%。我们的数据还表明，肩胛盂外侧化和下侧化对肩胛切迹有影响。我们无法确定降低的肩胛切迹发生率是否仅归因于 NSA 的降低。尽管肩胛切迹发生率较低，但 NSA 为 135°的组并未显示出任何显著更好的临床和功能结果。
