解剖型全肩关节置换术治疗 B2 型肩盂，采用非对称扩孔技术，与 A 型肩盂相比，在平均 9 年的随访中具有同等的生存率和患者结局。

Anatomic total shoulder arthroplasty for B2 glenoids treated with asymmetric reaming has equivalent survivorship and patient outcomes compared with type A glenoids at a mean 9-year follow-up.

机构信息

Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA.

出版信息

J Shoulder Elbow Surg. 2024 Nov;33(11):2392-2399. doi: 10.1016/j.jse.2024.03.030. Epub 2024 Apr 28.

DOI:10.1016/j.jse.2024.03.030

PMID:38688420

Abstract

BACKGROUND

Walch B2 glenoids can present a challenge to shoulder arthroplasty surgeons. Short-term studies have demonstrated that corrective reaming to 10° of retroversion in anatomic total shoulder arthroplasty (aTSA) can result in good outcomes; however, there is little data reporting the long-term outcomes in this cohort. B2 glenoids treated with high-side reaming present a theoretical risk of early glenoid component failure as one may ream into the subchondral bone. This study aimed to demonstrate that (1) B2 glenoids treated with corrective reaming have durable results and (2) offer similar results to Walch A1/2 in long-term follow-up.

METHODS

Patients who underwent aTSA by a single surgeon (E.L.F.) were identified from a shoulder arthroplasty registry. Inclusion criteria included Walch A1, A2, or B2 glenoid; a diagnosis of primary shoulder osteoarthritis; and a minimum radiographic and clinical follow-up of 5 years. Forty-three patients with B2 glenoids were compared to a cohort of 42 patients with A1 or A2 glenoids. Preoperative computed tomography (CT) and radiographs were used to assess deformity, glenoid version, and posterior subluxation of the humeral head. Postoperatively, patients were assessed with radiographs and patient-reported outcome measures including American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Simple Shoulder Test (SST) score, and visual analog scale (VAS).

RESULTS

Eighty-five shoulders (82 patients, 42 B2 and 43 A1/A2 glenoids) with an average follow-up of 9.4 years were included. In the B2 cohort, the average retroversion was 21.1° and posterior subluxation was 69.4% compared with 10.6° (P < .001) and 57.5% (P < .001), respectively, in the A1 or A2 cohort. The cohort demographics were similar except for male sex (B2 69.8% vs. A1 or A2 37.2%, P = .008). There was no difference between the cohorts in their improvement in ASES (P = .807), SST (P = .586), and VAS (P = .930) scores. There was no difference in lateral humeral offset (P = .889) or acromial humeral interval (P = .468) between initial postoperative and final follow-up visits. Survivorship for B2 glenoids was 97.6%, 94.1%, and 73.3% at 5, 10, and 15 years, respectively, compared with 97.6%, 91.9%, and 83.5% in type A glenoids. The revision rate was similar between the 2 groups (P = .432). Lazarus score (P = .682) and rates of humeral radiolucency (P = .366) and humeral osteolysis (P = .194) were similar between the 2 cohorts at final follow-up.

CONCLUSION

Asymmetric reaming of patients with B2 glenoids is a reliable method of glenoid preparation with excellent mid- to long-term clinical results, patient-reported outcomes, and low revision rates similar to their A1 and A2 counterparts.

摘要

背景

Walch B2 肩胛盂可能对肩关节置换术医生构成挑战。短期研究表明，在解剖全肩关节置换术（aTSA）中进行 10°的矫正扩孔可获得良好的结果；然而，在这一队列中，很少有数据报告长期结果。用高侧扩孔治疗的 B2 肩胛盂存在早期肩胛盂组件失效的理论风险，因为可能会扩孔到软骨下骨。本研究旨在证明：（1）用矫正扩孔治疗的 B2 肩胛盂具有持久的效果；（2）在长期随访中提供与 Walch A1/2 相似的结果。

方法

从肩关节置换登记处确定由一位外科医生（E.L.F.）进行 aTSA 的患者。纳入标准包括 Walch A1、A2 或 B2 肩胛盂；原发性肩关节骨关节炎的诊断；以及至少 5 年的影像学和临床随访。将 43 例 B2 肩胛盂患者与 42 例 A1 或 A2 肩胛盂患者进行比较。术前计算机断层扫描（CT）和 X 线片用于评估畸形、肩胛盂倾斜度和肱骨头后脱位。术后，通过 X 线片和患者报告的结果测量（包括美国肩肘外科医生肩关节评估标准表（ASES）评分、简易肩部测试（SST）评分和视觉模拟评分（VAS））进行评估。

结果

共纳入 85 个肩部（82 例患者，42 例 B2 和 43 例 A1/A2 肩胛盂），平均随访时间为 9.4 年。在 B2 队列中，平均后倾为 21.1°，肱骨头后脱位为 69.4%，而 A1 或 A2 队列分别为 10.6°（P<0.001）和 57.5%（P<0.001）。队列的人口统计学特征除男性比例（B2 为 69.8%，A1 或 A2 为 37.2%，P=0.008）外，其他均相似。两组患者在 ASES（P=0.807）、SST（P=0.586）和 VAS（P=0.930）评分方面的改善无差异。在最终随访时，两组患者的外侧肱骨偏移（P=0.889）或肩峰肱骨关节间隙（P=0.468）无差异。B2 肩胛盂的 5 年、10 年和 15 年生存率分别为 97.6%、94.1%和 73.3%，而 A 型肩胛盂的生存率分别为 97.6%、91.9%和 83.5%。两组的翻修率无差异（P=0.432）。在最终随访时，两组的 Lazarus 评分（P=0.682）、肱骨透亮率（P=0.366）和肱骨溶骨率（P=0.194）相似。