From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid).
J Am Acad Orthop Surg Glob Res Rev. 2024 Aug 12;8(8). doi: 10.5435/JAAOSGlobal-D-24-00174. eCollection 2024 Aug 1.
The purpose of this study was to evaluate clinical outcomes after tendon transfers in the setting of reverse total shoulder arthroplasty (RTSA).
PubMed and Embase were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to find primary clinical studies of any type of tendon transfer in the setting of RTSA.
Overall, 17 studies (level of evidence [LOE] I: 1, LOE II: 0, LOE III: 3, LOE IV: 13) met inclusion criteria, with 300 shoulders. Most patients were female (56.7%), with an average age of 68.7 years (range 19 to 89) and a mean follow-up of 46.2 months (range 6 to 174). 11 studies reported outcomes after combined latissimus dorsi and teres major transfer (LDTM) while eight studies reported on latissimus dorsi transfer only (LD). Improvements in commonly reported subjective and functional outcome measures were as follows: external rotation +32° (LDTM) and +30° (LD), flexion +65° (LDTM) and +59° (LD), Visual Analog Score -5.4 (LDTM) and -4.5 (LD), subjective shoulder value +43.8% (LDTM) and +46.3% (LD), and overall Constant score +33.8 (LDTM) and +38.7 (LD). The overall complication rate was 11.3%, including tendon transfer ruptures (0.7%), instability (3.0%), infection (2.0%), and nerve injury (0.3%). The all-cause repeat operation rate was 7.3%, most commonly for arthroplasty revision (5.3%). Subgroup analysis revealed that lateralized implants with tendon transfer resulted in markedly greater improvements in Constant score, flexion, ER1, and ER2 while medialized implants with tendon transfer had markedly greater improvements in Visual Analog Score, subjective shoulder value, and abduction.
Patients undergoing tendon transfer of either combined LDTM or latissimus dorsi alone in the setting of RTSA have markedly improved subjective and functional outcomes. A moderate incidence of complications (11.3%) was noted in this patient population.
本研究旨在评估反式全肩关节置换术（RTSA）背景下肌腱转移的临床效果。
根据系统评价和荟萃分析的首选报告项目，在 PubMed 和 Embase 上搜索了各种类型的肌腱转移在 RTSA 背景下的原始临床研究。
共有 17 项研究（证据水平 [LOE] I：1，LOE II：0，LOE III：3，LOE IV：13）符合纳入标准，共 300 例肩关节。大多数患者为女性（56.7%），平均年龄为 68.7 岁（19-89 岁），平均随访时间为 46.2 个月（6-174 个月）。11 项研究报告了Latissimus dorsi 和teres major 联合转移（LDTM）后的结果，8 项研究报告了 Latissimus dorsi 转移的结果。以下是常用的主观和功能结果测量的改善情况：外旋+32°（LDTM）和+30°（LD），屈曲+65°（LDTM）和+59°（LD），视觉模拟评分-5.4（LDTM）和-4.5（LD），主观肩价值+43.8%（LDTM）和+46.3%（LD），以及整体常数评分+33.8%（LDTM）和+38.7%（LD）。总体并发症发生率为 11.3%，包括肌腱转移破裂（0.7%）、不稳定（3.0%）、感染（2.0%）和神经损伤（0.3%）。所有原因的再次手术率为 7.3%，最常见的是关节置换翻修（5.3%）。亚组分析显示，带有肌腱转移的外侧化植入物在Constant 评分、屈曲、ER1 和 ER2 方面有明显的改善，而带有肌腱转移的内侧化植入物在视觉模拟评分、主观肩价值和外展方面有明显的改善。
在 RTSA 背景下接受 Latissimus dorsi 或 LDTM 肌腱转移的患者的主观和功能结果有明显改善。在这一患者群体中，并发症的发生率（11.3%）中等。
