Department of Orthopedic Surgery, Chung-Ang University Medical Center, Chung-Ang University School of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Korea.
Clin Orthop Surg. 2023 Aug;15(4):627-636. doi: 10.4055/cios22343. Epub 2023 Jun 14.
Deltoid function critically influences the results of reverse total shoulder arthroplasty (RTSA), and spontaneous deltoid attrition tears are frequently detected in cuff tear arthropathy (CTA) patients; however, the clinical impacts of these tears on RTSA outcomes are undetermined. Our aim was to determine the effect of spontaneous deltoid attrition tears on postoperative outcomes after RTSA without an additional deltoid procedure.
Seventy-two patients who underwent RTSA for CTA with preoperative magnetic resonance imaging (MRI) and a minimum clinical follow-up of 1 year (mean, 32 months) were retrospectively reviewed in the study. Patients with a history of previous shoulder surgery or injury were excluded. The presence and location of deltoid attrition tears were determined in preoperative MRI. Propensity score matching (1:1) was performed to construct tear and no-tear groups. Finally, 21 patients, matched with respect to age, sex, hand dominance, symptom duration, medical comorbidity (obesity, diabetes mellitus, and coronary artery disease), Hamada grade, and implant type, were assigned to each group. Clinical outcomes (functional scores, isometric power, and range of motion) in the two groups were compared.
Deltoid attrition tears were detected in 21 of the 72 enrolled cases (29.1%). Anterolateral deltoid was the most frequent location and no tear was detected in the posterior deltoid. The tear rate increased with disease severity (Hamada G2, 4.8%; G3, 23.8%; > G4, 71.4%). No pre- or postoperative clinical variables differed significantly between the tear and no tear groups.
Deltoid attrition tears were detected in 29% of CTA patients who underwent RTSA. The most common site was the anterolateral region and tear prevalence tended to increase with CTA progression. However, RTSA was found to provide satisfactory outcomes regardless of the presence of a deltoid attrition tear.
三角肌功能对反式全肩关节置换术（RTSA）的结果有重要影响，肩袖撕裂性关节病（CTA）患者常发现三角肌自发性磨损撕裂，但这些撕裂对 RTSA 结果的临床影响尚未确定。我们的目的是确定在不进行额外三角肌手术的情况下，RTSA 后三角肌自发性磨损撕裂对术后结果的影响。
本研究回顾性分析了 72 例接受 RTSA 治疗 CTA 的患者的术前磁共振成像（MRI）和至少 1 年（平均 32 个月）的临床随访资料。排除有既往肩部手术或损伤史的患者。在术前 MRI 中确定三角肌磨损撕裂的存在和位置。采用倾向评分匹配（1:1）构建撕裂组和无撕裂组。最终，根据年龄、性别、手优势、症状持续时间、合并症（肥胖、糖尿病和冠心病）、Hamada 分级和植入物类型，将 21 例患者匹配到每组，比较两组的临床结果（功能评分、等长肌力和活动范围）。
72 例患者中有 21 例（29.1%）发现三角肌磨损撕裂。最常见的部位是前外侧三角肌，后三角肌无撕裂。撕裂率随疾病严重程度增加（Hamada G2，4.8%；G3，23.8%；>G4，71.4%）。撕裂组和无撕裂组之间的术前和术后临床变量无显著差异。
在接受 RTSA 的 CTA 患者中，29%发现三角肌磨损撕裂。最常见的部位是前外侧区，随着 CTA 的进展，撕裂的发生率有增加的趋势。然而，无论是否存在三角肌磨损撕裂，RTSA 都能提供满意的结果。
