Krupp Ryan, O'Grady Christopher, Werner Brian, Wiater J Michael, Nyland John, Duquin Thomas
Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
Andrews Research and Education Foundation, Gulf Breeze, FL, USA.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):1045-1056. doi: 10.1007/s00590-023-03757-x. Epub 2023 Oct 29.
Augmented glenoid baseplate and offset humeral tray reverse total shoulder arthroplasty (RTSA) implants may decrease the mechanical impingement that creates scapular notching and improve shoulder function. This study evaluated the clinical efficacy of three different RTSA glenoid baseplate and offset humeral tray combinations for patient-reported shoulder function, pain and instability, radiographic imaging evidence of glenoid baseplate or humeral stem subsidence and migration, bony changes associated with implant loosening, and scapular notching over the initial 2 years post-RTSA. Primary outcomes included active shoulder mobility, perceived function, pain, instability, scapular notching, and implant survival.
Sixty-seven patients from 6 research sites received one of three different glenoid baseplate and humeral tray combinations. Group 1 (n = 21) received a mini-augmented glenoid baseplate with a standard humeral tray; Group 2 (n = 23) received a standard glenoid baseplate and a mini-humeral tray with 3 trunnion offset options; Group 3 (n = 23) received both a mini-augmented glenoid baseplate and a mini-humeral tray with 3 trunnion offset options. Subjects underwent radiologic evaluation, completed the ASES scale, the EQ-5D-5L quality of life scale, VAS shoulder pain and instability questions, and active shoulder mobility measurements pre-operatively, and 6-weeks, 6-months, 1-2 years post-RTSA.
Improved active shoulder mobility, quality of life, perceived function, decreased shoulder pain and instability, excellent implant survival and minimal scapular notching were observed for all groups. Group 3 had better overall active shoulder mobility than the other groups and better perceived function than Group 1.
The group that received the mini-augmented glenoid baseplate and mini-humeral tray combination had better overall active shoulder flexion, external rotation at 90° abduction, and internal rotation. This group also had better perceived shoulder function compared to the group that received a mini-augmented glenoid baseplate with a standard humeral tray.
增强型肩胛盂基板和偏移型肱骨头托盘的反向全肩关节置换术（RTSA）植入物可能会减少导致肩胛切迹的机械撞击，并改善肩部功能。本研究评估了三种不同的RTSA肩胛盂基板和偏移型肱骨头托盘组合对患者报告的肩部功能、疼痛和不稳定情况、肩胛盂基板或肱骨干下沉及移位的影像学证据、与植入物松动相关的骨质变化以及RTSA术后最初2年内的肩胛切迹的临床疗效。主要结局包括主动肩部活动度、感知功能、疼痛、不稳定、肩胛切迹和植入物存活率。
来自6个研究地点的67名患者接受了三种不同的肩胛盂基板和肱骨头托盘组合之一。第1组（n = 21）接受微型增强型肩胛盂基板和标准肱骨头托盘；第2组（n = 23）接受标准肩胛盂基板和具有3种耳轴偏移选项的微型肱骨头托盘；第3组（n = 23）接受微型增强型肩胛盂基板和具有3种耳轴偏移选项的微型肱骨头托盘。受试者在术前、RTSA术后6周、6个月、1 - 2年接受放射学评估，完成ASES量表、EQ - 5D - 5L生活质量量表、VAS肩部疼痛和不稳定问题以及主动肩部活动度测量。
所有组均观察到主动肩部活动度改善、生活质量提高、感知功能增强、肩部疼痛和不稳定减轻。植入物存活率高，肩胛切迹极少。第3组的总体主动肩部活动度优于其他组，感知功能优于第1组。
接受微型增强型肩胛盂基板和微型肱骨头托盘组合的组在总体主动肩部前屈、90°外展位外旋和内旋方面表现更好。与接受微型增强型肩胛盂基板和标准肱骨头托盘的组相比，该组的肩部功能感知也更好。
