Patel Akshar V, White Christopher A, Cirino Carl M, Duey Akiro H, Ranson William A, Gross Benjamin D, Mease Samuel, Galatz Leesa M, Parsons Bradford O, Flatow Evan L, Cagle Paul J
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):799-807. doi: 10.1007/s00590-023-03708-6. Epub 2023 Sep 14.
The utilization of reverse total shoulder arthroplasty now exceeds the incidence of anatomic shoulder arthroplasty. Previous mid-to-long-term studies on rTSA have reported a decrease in shoulder function as follow-up increased. The purpose of this study was to provide data on mid-term outcomes and implant survival in a series focusing on reverse total shoulder arthroplasty.
Demographic information such as age at surgery, revision surgery status, BMI, and smoking status were recorded. The clinical endpoints measured in this study were range of motion scores (forward elevation, external rotation, internal rotation) and patient reported outcomes (VAS, ASES, SST). Radiographic variables captured included preoperative glenoid morphology, humeral lucency, and glenoid loosening.
Fifty-six shoulders were included in this study. The overall mean age at surgery was 72.5 ± 7.2 years with an average follow-up time of 6.8 ± 3.5 years. The mean BMI was 28.1 ± 5.5. All measurements of range of motion saw significant and sustained improvements. Overall, forward elevation improved from 82° preoperatively to 133° postoperatively (p < 0.01). External rotation improved from 23° preoperatively to 36° (p < 0.01), while internal rotation improved from L3 to L1 (p = 0.05). ASES scores improved from 31 preoperatively to 70 postoperatively (p < 0.01). SST scores improved from 2 preoperatively to 7 (p < 0.01). VAS pain index scores improved from 6 to 2 following surgery (p < 0.01). Postoperative scapular notching was seen in 18 patients at final follow-up. Glenoid loosening was seen in 3 shoulders. Humeral loosening was seen in 18 shoulders. Tuberosity resorption was seen in 8 shoulders. The 5 year survival estimate was 98%, and the 10 year survival estimate was 83%.
In this series, we found that rTSA provides mid-term improvements in range of motion in patients while reducing pain levels. When considered together, this demonstrates that most patients undergoing rTSA can have excellent use of their shoulder from age at surgery to end-of-life.
目前，反式全肩关节置换术的应用超过了解剖型肩关节置换术的发生率。以往关于反式全肩关节置换术的中长期研究报告称，随着随访时间的增加，肩关节功能有所下降。本研究的目的是提供一系列聚焦于反式全肩关节置换术的中期疗效和植入物生存率的数据。
记录手术年龄、翻修手术状态、体重指数（BMI）和吸烟状况等人口统计学信息。本研究测量的临床终点为活动度评分（前屈、外旋、内旋）和患者报告的结局（视觉模拟评分法[VAS]、美国肩肘外科医师学会评分[ASES]、简单肩部测试[SST]）。记录的影像学变量包括术前肩胛盂形态、肱骨透亮区和肩胛盂松动情况。
本研究纳入了56例肩部病例。手术时的总体平均年龄为72.5±7.2岁，平均随访时间为6.8±3.5年。平均BMI为28.1±5.5。所有活动度测量值均有显著且持续的改善。总体而言，前屈从术前的82°改善至术后的133°（p<0.01）。外旋从术前的23°改善至36°（p<0.01），而内旋从L3改善至L1（p=0.05）。ASES评分从术前的31分提高至术后的70分（p<0.01）。SST评分从术前的2分提高至7分（p<0.01）。术后VAS疼痛指数评分从6分降至2分（p<0.01）。末次随访时，18例患者出现术后肩胛盂切迹。3例肩部出现肩胛盂松动。18例肩部出现肱骨松动。8例肩部出现结节吸收。5年生存率估计为98%，10年生存率估计为83%。
在本系列研究中，我们发现反式全肩关节置换术可在中期改善患者的活动度，同时降低疼痛程度。综合来看，这表明大多数接受反式全肩关节置换术的患者从手术年龄到生命结束都能很好地使用其肩部。
