Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, Gladiolo, S/N, Mostoles, Madrid, Spain.
Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3565-3571. doi: 10.1007/s00167-023-07377-0. Epub 2023 May 2.
The comprehensive arthroscopic management (CAM) procedure is a useful joint-preserving option for young or active patients with glenohumeral osteoarthritis (GHOA). Our objective was to evaluate the results and prognostic factors of the CAM procedure without direct axillary nerve release or subacromial decompression.
A retrospective observational study among patients with GHOA who underwent the CAM procedure was conducted. Neither axillary nerve neurolysis nor subacromial decompression was performed. Both primary and secondary GHOA were considered; the latter was defined as a history of shoulder pathology (mainly instability or proximal humerus fracture). The American Shoulder and Elbow Surgeons scale, Simple Shoulder Test, Visual Analogue Scale, activity level, Single Assessment Numeric Evaluation, EuroQol 5 Dimensions 3 Levels, Western Ontario Rotator Cuff Index, and active range of motion (aROM) were analysed.
Twenty-five patients who underwent the CAM procedure met the inclusion criteria. After a mean follow-up of 42.4 ± 22.9 months, we found improvement (p < 0.001) in all postoperative values of the different scales. The procedure increased aROM overall. Patients with arthropathy due to instability showed worse results. The rate of CAM failures, defined as conversion to shoulder arthroplasty, was 12%.
This study showed that the CAM procedure without direct axillary nerve neurolysis or subacromial decompression might be a valid alternative in active patients with advanced GHOA to improve shoulder function (aROM and scores), decrease pain, and delay arthroplasty. This technique showed good subjective functional scores, high patient satisfaction, and a low rate of complications.
IV.
综合关节镜下处理（CAM）程序是一种保留关节的有效方法，适用于患有肩肱关节炎（GHOA）的年轻或活跃患者。我们的目的是评估不进行直接腋神经松解或肩峰下减压的 CAM 手术的结果和预后因素。
对接受 CAM 手术的 GHOA 患者进行回顾性观察性研究。既不进行腋神经神经松解术，也不进行肩峰下减压术。既考虑原发性 GHOA，也考虑继发性 GHOA；后者定义为有肩部病史（主要为不稳定或肱骨近端骨折）。评估美国肩肘外科医师评分（ASES）、简易肩部测试（SST）、视觉模拟评分（VAS）、活动水平、单项评估数值评估（SANE）、欧洲五维健康量表 3 级（EQ-5D-3L）、西部安大略省肩肘外科评分（WOSI）和主动活动范围（aROM）。
符合纳入标准的 25 例患者接受了 CAM 手术。平均随访 42.4±22.9 个月后，我们发现所有术后评分均有改善（p<0.001）。该手术总体上增加了 aROM。由于不稳定导致关节炎的患者结果较差。CAM 手术失败的比例（定义为转为肩关节置换术）为 12%。
本研究表明，不进行直接腋神经松解或肩峰下减压的 CAM 手术可能是一种有效的替代方法，适用于患有晚期 GHOA 的活跃患者，以改善肩部功能（aROM 和评分）、减轻疼痛和延迟关节置换。该技术显示出良好的主观功能评分、患者满意度高和并发症发生率低。
IV。
