Casa di Cura Villa Betania, Rome, Italy.
A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.
Arch Orthop Trauma Surg. 2024 Jan;144(1):41-49. doi: 10.1007/s00402-023-05025-3. Epub 2023 Aug 18.
The role of the subscapularis (Ssc) tendon does not yet have a well-defined role in RSA. The purpose of the present study was to evaluate if the repair of the Ssc in RSA improves overall clinical and radiographic results and if it has the same results using a medialized design humeral stem compared to a lateralized design.
Eighty-four consecutive patients undergoing RSA were retrospectively analyzed. Nine patients were lost at FU. Two implants with similar glenosphere design and different stem design (medialized and lateralized) were used. The Ssc was repaired in case of good quality of the fibers and reducibility without tension intraoperatively. Patients were divided into four groups for data analysis depending on whether they had received a medialized or lateralized design and Ssc repair or not. Patients were reviewed at an average follow-up of 40.8 ± 13.1 months. Clinical outcome measures included Active range of motion (ROM), strength, visual analog scale (VAS), Constant-Murley score (CMS), and the American Shoulder and Elbow Surgeons score (ASES). Radiographic evaluation at final follow-up was performed to assess scapular notching, stress shielding, and radiolucent lines.
No statistically significant clinical differences (p > 0.05) emerged between Lat/Ssc+ and Lat/Ssc-. Conversely, the patients belonging to the Med/Ssc- group reported statistically worse (p < 0.05) results than the Med/Ssc + group in terms of VAS, ASES and CMS. Statistically worse (p < .05) results in the Med/Ssc- group than in the Med/Ssc + were found also in active ROM achieved in FE, ABD, ER1 and ER2, and in the strength obtained in FE, ABD and ER2. Scapular notching was reported in 3 shoulders (15.7%) in Lat/Ssc+ group and in 7 shoulders (50%) in Lat/Ssc- group, while it was reported in 4 shoulders (14.2%) in Med/Ssc + group and in 6 shoulders (42.8%) in Med/Ssc- group. Stress shielding was observed in 6 cases in Lat/Ssc+ group (31.6%), in 8 cases in Lat/Ssc- group (57.1%), in 3 cases (10.7%) in Med/Ssc + group and 4 cases in Med/Ssc- group (28.6%).
Patients undergoing RSA show clinical improvements at mid-term follow-up with a low rate of complications, regardless of the use of a medialized or a lateralized humeral stem design. Ssc repair is associated with better functional outcomes in the cohort of medialized stem, while it did not yield significant differences in the cohort of lateralized stem.
Level III; Retrospective Cohort Comparison; Treatment Study.
肩胛下肌（Ssc）肌腱在 RSA 中的作用尚未明确。本研究的目的是评估 RSA 中 Ssc 修复是否能改善整体临床和影像学结果，以及与外侧化设计相比，使用内侧化设计的肱骨柄是否具有相同的效果。
回顾性分析了 84 例连续接受 RSA 的患者。随访时丢失了 9 例患者。使用两种具有相似的球窝设计但柄设计不同（内侧化和外侧化）的假体。术中在 Ssc 纤维质量良好且可复位且无张力的情况下进行修复。根据是否接受内侧化或外侧化设计以及是否进行 Ssc 修复，将患者分为四组进行数据分析。患者平均随访 40.8±13.1 个月。临床疗效评估包括主动活动范围（ROM）、力量、视觉模拟评分（VAS）、Constant-Murley 评分（CMS）和美国肩肘外科医生评分（ASES）。在最终随访时进行影像学评估，以评估肩胛切迹、应力遮挡和透亮线。
Lat/Ssc+和 Lat/Ssc-组之间没有统计学上的显著临床差异（p＞0.05）。相反，属于 Med/Ssc-组的患者在 VAS、ASES 和 CMS 方面的报告结果明显差于 Med/Ssc+组（p＜0.05）。Med/Ssc-组在 FE、ABD、ER1 和 ER2 中获得的主动 ROM 以及在 FE、ABD 和 ER2 中获得的力量方面的结果也明显差于 Med/Ssc+组。Lat/Ssc+组有 3 例（15.7%）出现肩胛切迹，Lat/Ssc-组有 7 例（50%）出现肩胛切迹，Med/Ssc+组有 4 例（14.2%）出现肩胛切迹，Med/Ssc-组有 6 例（42.8%）出现肩胛切迹。Lat/Ssc+组有 6 例（31.6%）出现应力遮挡，Lat/Ssc-组有 8 例（57.1%）出现应力遮挡，Med/Ssc+组有 3 例（10.7%）出现应力遮挡，Med/Ssc-组有 4 例（28.6%）出现应力遮挡。
无论使用内侧化还是外侧化肱骨柄设计，接受 RSA 的患者在中期随访时均可获得临床改善，且并发症发生率较低。Ssc 修复与内侧化柄的功能结局改善相关，而在外侧化柄的队列中，Ssc 修复并未产生显著差异。
III 级；回顾性队列比较；治疗研究。
