Clinique du Parc, ELSAN, Lyon, France.
Clinique du Parc, ELSAN, Lyon, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France.
J Shoulder Elbow Surg. 2024 Feb;33(2):328-334. doi: 10.1016/j.jse.2023.06.021. Epub 2023 Jul 20.
Hemishoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads, which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to midterm (5-9 years).
We retrieved the records of 45 consecutive patients who underwent HSA with pyrocarbon humeral heads from 2013 to 2017. Patients were evaluated radiographically and clinically at a first follow-up (2-4 years) and a second follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography scans, and glenoid erosion was assessed using plain radiographs according to Sperling et al. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) score were assessed by an independent observer.
From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion) and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At the first follow-up of 2.2 ± 0.4 years, all clinical scores improved substantially (CS from 29.3 ± 13.5 to 76.7 ± 14.4, ASES from 23.7 ± 15.6 to 87.0 ± 16.0, and SSV from 25.3 ± 12.2 to 84.1 ± 15.2), and at the second follow-up of 6.2 ± 1.2 years, good clinical scores were maintained (CS from 76.7 ± 14.4 to 80.8 ± 16.0, ASES from 87.0 ± 16.0 to 92.3 ± 15.0, and SSV from 84.1 ± 15.2 to 82.8 ± 18.3). At the second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing with immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n = 9) or 2 grades (n = 1).
Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.
对于有轻度肩胛盂侵蚀或畸形、活动量小的年轻患者，半肩置换术（HSA）是全肩关节置换术的一种更保守的替代方案。与金属肱骨头相比，多孔炭质肱骨头的出现是为了替代金属肱骨头，金属肱骨头与肩胛盂侵蚀有关，发生率为 28%-43%。本研究的目的是评估使用多孔炭质肱骨头的 HSA 的肩胛盂侵蚀进展和临床评分，随访时间从短期（2-4 年）到中期（5-9 年）。
我们回顾了 2013 年至 2017 年间 45 例连续接受 HSA 治疗的患者的记录。患者在初次随访（2-4 年）和第二次随访（5-9 年）时进行影像学和临床评估。使用 CT 扫描评估术前肩胛盂形态，使用平片根据 Sperling 等人的方法评估肩胛盂侵蚀。由独立观察者评估 Constant 评分（CS）、美国肩肘外科医生（ASES）评分和主观肩部值（SSV）评分。
在最初的 45 例患者中，2 例（4.4%）因持续疼痛（无肩袖病变或肩胛盂侵蚀迹象）行翻修手术，6 例（13%）失访，37 例（82%）用于疗效评估。在初次随访的 2.2±0.4 年时，所有临床评分均显著提高（CS 从 29.3±13.5 提高至 76.7±14.4，ASES 从 23.7±15.6 提高至 87.0±16.0，SSV 从 25.3±12.2 提高至 84.1±15.2），在第二次随访的 6.2±1.2 年时，仍保持较好的临床评分（CS 从 76.7±14.4 提高至 80.8±16.0，ASES 从 87.0±16.0 提高至 92.3±15.0，SSV 从 84.1±15.2 提高至 82.8±18.3）。在第二次随访时，9 例（24%）肩胛盂侵蚀为中度，3 例（8.1%）为重度。与术后即刻的 X 线片相比，10 例（10 肩）肩胛盂侵蚀进展 1 级（n=9）或 2 级（n=1）。
多孔炭质肱骨头用于 HSA 可获得令人满意的临床评分，且肩胛盂侵蚀较少。
