60 岁以下患者行反肩关节置换术后的内旋功能恢复可能因病因而异：一项多中心回顾性研究。
Restoration of internal rotation after reverse shoulder arthroplasty may vary depending on etiology in patients younger than 60 years of age: a multicenter retrospective study.
机构信息
Université de Tours, Faculté de Médecine de Tours, CHRU Trousseau Service d'Orthopédie Traumatologie, 1C Avenue de la République, 37170 Chambray-les-Tours, France; Université de Tours, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Equipe Reconnaissance de Forme et Analyse de l'Image, 64 Avenue Portalis, 37200 Tours, France.
Université de Tours, Faculté de Médecine de Tours, CHRU Trousseau Service d'Orthopédie Traumatologie, 1C Avenue de la République, 37170 Chambray-les-Tours, France; Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
出版信息
J ISAKOS. 2024 Aug;9(4):620-627. doi: 10.1016/j.jisako.2024.05.016. Epub 2024 Jun 6.
BACKGROUND
Reverse shoulder arthroplasty (RSA) offers promising functional outcomes for young patients, yet challenges persist in restoring internal rotation (IR). This study aimed to assess the restoration of IR after RSA in patients younger than 60 years of age and analyze the factors affecting IR recovery.
METHODS
A retrospective multicenter study was conducted, examining the functional outcome of patients who underwent RSA, with a minimum follow-up period of 2 years. Two subgroups of patients who underwent primary RSA were analyzed separately with respect to active internal rotation with the elbow at the side (AIR1): "difficult AIR1" and "easy AIR1."
RESULTS
The study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active IR (p < 0.01). According to etiology, statistically significant improvement (p < 0.05) in active IR was observed for fracture sequelae, primary osteoarthritis, and rheumatoid arthritis, whereas no statistically significant improvement in IR was observed for tumor, revision, and cuff-tear arthropathy (p > 0.05). In subgroup analysis, patients with easy AIR1 displayed a statistically significant lower body mass index and better Constant score mobility, as well as improved motion in forward elevation and active IR (p < 0.05). No statistically significant associations were found between improved IR and prosthetic design or subscapularis repair. Scapular notch, lysis of the graft, and teres minor atrophy were significantly associated with better active IR (p < 0.05).
CONCLUSION
RSA improves active RoM, pain, and functional outcomes in patients aged under 60. However, the degree of improvement in IR may vary depending on several factors and the underlying etiologies. These insights are crucial for patient selection and counseling, guiding RSA optimization efforts.
LEVEL OF EVIDENCE
IV.
背景
反式肩关节置换术（RSA）为年轻患者提供了有前景的功能结果，但在恢复内旋（IR）方面仍存在挑战。本研究旨在评估 60 岁以下 RSA 术后患者的 IR 恢复情况，并分析影响 IR 恢复的因素。
方法
进行了一项回顾性多中心研究，检查了接受 RSA 治疗的患者的功能结果，随访时间至少为 2 年。根据是否容易实现主动内旋（AIR1），将接受初次 RSA 的两组患者（主动内旋 1 侧肘）进行单独分析：“困难 AIR1”和“容易 AIR1”。
结果
该研究共纳入 136 例患者（总体系列），平均年龄为 51.6 岁。总体系列在主动活动范围（RoM）、疼痛和 Constant 评分方面均有统计学显著改善，尤其是在主动内旋方面（p<0.01）。根据病因，骨折后遗症、原发性骨关节炎和类风湿性关节炎患者的主动内旋改善有统计学显著意义（p<0.05），而肿瘤、翻修和肩袖撕裂性关节炎患者的内旋无统计学显著改善（p>0.05）。在亚组分析中，容易实现 AIR1 的患者的体重指数较低，Constant 评分移动性更好，前屈和主动内旋运动改善（p<0.05）。内旋改善与假体设计或肩胛下肌修复之间无统计学显著关联。肩胛切迹、移植物溶解和小圆肌萎缩与更好的主动内旋显著相关（p<0.05）。
结论
RSA 可改善 60 岁以下患者的主动活动范围、疼痛和功能结果。然而，IR 的改善程度可能因多种因素和潜在病因而异。这些见解对于患者选择和咨询至关重要，指导 RSA 优化努力。
证据水平
IV。
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