Scarcella Michael J, Yalcin Sercan, Ginesin Eyal, Patel Ronak, Miniaci Anthony
Cleveland Clinic Orthopaedic and Rheumatology Institute, Avon, OH, USA.
Hinsdale Orthopaedic, Hinsdale, IL, USA.
JSES Rev Rep Tech. 2022 May 19;2(3):285-296. doi: 10.1016/j.xrrt.2022.04.007. eCollection 2022 Aug.
Shoulder osteoarthritis (OA) with eccentric (B) glenoids has generally been associated with poor patient-reported outcomes and increased complications. The purpose of this study was to outline all the described treatment options and their outcomes and complications in order to better guide treatment.
This systematic review was performed according to the Preferred Reporting Items for Systematic review and Meta-analysis guidelines. Searches were performed up to December 19, 2019, using Medline, EMBASE, Scopus, and Cochrane databases. Inclusion criteria included studies for glenohumeral OA reporting posterior humeral head subluxation and/or posterior glenoid erosion. Studies were excluded if they were review papers, abstracts, or conference papers; had heterogeneity of included Walch types; or were not written in English.
Twenty-one studies met inclusion criteria. The mean follow-up duration was 47.5 months (range, 14-300), and the mean patient age 62 years (38-88). Six different discernible techniques were identified: asymmetric reaming with onlay glenoid (AROG) in 267 shoulders, posterior glenoid bone grafting (PGBG) with onlay glenoid in 79 shoulders, augmented glenoid (AG) in 160 shoulders, reverse shoulder arthroplasty (RSA) with or without bone grafting in 118 shoulders, hemiarthroplasty with concentric reaming (HACR) in 57 shoulders, and humeral head arthroplasty with inlay glenoid (HAIG) in 36 shoulders. All techniques reported improved patient outcomes and range of motion. Short-term (<5 years) studies reported glenoid loosening leading to revisions in 3% of AROG, 2.7% PGBG, 0.8% AG, 1.4% RSA, and 0% HAIG shoulders. HACR had a high revision rate (12.3%) due to persistent pain and stiffness. Midterm (>5 years) studies demonstrated increased rates of glenoid loosening with AROG (14.5%), PGBG (21% loose, 23.8% "at risk"), and AG (18.9% "at risk"), as well as increased rates of subluxation or revision due to instability. HAIG did not demonstrate loosening, subluxation, or revision at 55.2 months.
Various techniques exist to manage complex primary glenohumeral OA with posterior subluxation and posterior glenoid erosion. Glenoid component survival is a concern with ASOG, PGBG, and AG. HACR has the highest early revision rate. RSA offers promising short-term and midterm results likely due to the advantage of more secure fixation as well as a constrained design to prevent posterior subluxation. HAIG has the lowest complication and revision rates although further long-term studies are needed.
伴有偏心（B型）肩胛盂的肩关节骨关节炎（OA）通常与患者报告的不良预后及并发症增加相关。本研究的目的是概述所有已描述的治疗选择及其结果和并发症，以便更好地指导治疗。
本系统评价按照系统评价和Meta分析的首选报告项目指南进行。截至2019年12月19日，使用Medline、EMBASE、Scopus和Cochrane数据库进行检索。纳入标准包括报告肱骨头后脱位和/或肩胛盂后侵蚀的盂肱关节OA研究。如果研究为综述论文、摘要或会议论文；纳入的Walch类型存在异质性；或非英文撰写，则予以排除。
21项研究符合纳入标准。平均随访时间为47.5个月（范围14 - 300个月），患者平均年龄62岁（38 - 88岁）。确定了六种不同的可识别技术：267例肩关节采用带嵌体肩胛盂的不对称扩孔术（AROG），79例肩关节采用带嵌体肩胛盂的肩胛盂后植骨术（PGBG），160例肩关节采用增强肩胛盂（AG），118例肩关节采用带或不带植骨的反式肩关节置换术（RSA），57例肩关节采用同心扩孔的半关节置换术（HACR），36例肩关节采用带嵌体肩胛盂的肱骨头置换术（HAIG）。所有技术均报告患者预后和活动范围得到改善。短期（<5年）研究报告，AROG的3%、PGBG的2.7%、AG的0.8%、RSA的1.4%和HAIG的0%肩关节因肩胛盂松动导致翻修。HACR因持续疼痛和僵硬而翻修率较高（12.3%）。中期（>5年）研究表明，AROG（14.5%）、PGBG（21%松动，23.8%“有风险”）和AG（18.9%“有风险”）的肩胛盂松动率增加，以及因不稳定导致的半脱位或翻修率增加。HAIG在55.2个月时未出现松动、半脱位或翻修。
存在多种技术可用于处理伴有后脱位和肩胛盂后侵蚀的复杂原发性盂肱关节OA。肩胛盂组件的生存率是ASOG、PGBG和AG关注的问题。HACR的早期翻修率最高。RSA提供了有前景的短期和中期结果，可能是由于更可靠固定的优势以及防止后脱位的受限设计。HAIG的并发症和翻修率最低，尽管需要进一步的长期研究。
