Amorim-Barbosa Tiago, Ribau Ana, Fonte Hélder, Barros Luís Henrique, Claro Rui
Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal.
Shoulder Unit, Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal.
Clin Shoulder Elb. 2023 Mar;26(1):3-9. doi: 10.5397/cise.2022.01270. Epub 2023 Jan 17.
Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA.
A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing.
At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation.
Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation.
采用骨增加偏移（BIO-RSA）对Grammont型反肩关节置换术（RSA）的内侧化设计进行改良已显示出更好的临床效果和更少的并发症。本研究的目的是比较接受标准RSA和BIO-RSA的患者之间的临床结果、并发症和影像学结果。
对42例RSA手术（22例标准RSA和20例BIO-RSA）进行回顾性分析。在至少1年的随访期内，比较了活动内旋（ROM）、Constant肩关节评分（CSS）、视觉模拟量表（VAS）和主观肩关节评分（SSS）。对X线片和计算机断层扫描（CT）进行检查，以评估肩胛切迹、关节盂和肱骨固定情况以及植骨愈合情况。
平均随访27.6个月（范围12 - 48个月），发现主动内旋（P = 0.038）和被动外旋（P = 0.013）存在显著差异，BIO-RSA的结果更好。在ROM、CSS（P = 0.884）、VAS评分和SSS方面未发现其他差异。通过CT扫描（n = 34）证实所有患者的植骨均愈合且存活。标准RSA组的切迹发生率为28%，BIO-RSA组为33%，但标准RSA的切迹更严重（2级），高于BIO-RSA（P = 0.039）。在关节盂和肱骨固定方面未发现其他显著差异。
与标准RSA相比，骨移植外侧化与更好的内旋和外旋以及更轻的肩胛切迹相关。骨移植有效融合，在影像学评估中未观察到相关变化。
