Suri Misty, Grilliot Jordan, Verma Arjun, Renshaw Andrew, Jones Deryk, Finger Simon
Ochsner Andrews Sports Medicine Institute, Ochsner Clinic Foundation, Jefferson, LA.
Tulane University School of Medicine, New Orleans, LA.
Ochsner J. 2024 Fall;24(3):207-212. doi: 10.31486/toj.23.0135.
Achondroplasia can result in many skeletal manifestations, and degenerative osteoarthritis can develop in patients with achondroplasia. Morphologic changes to both the humerus and glenoid-short humeri with patulous metaphyses and a medialized glenoid-can cause challenges that must be overcome to achieve a successful surgical result in a patient with shoulder dysfunction. Because patients with achondroplasia have near-normal life expectancies, the operative shoulder must be functional as well as quite durable in the long term. In an achondroplastic dwarf with shoulder osteoarthritis and rotator cuff insufficiency, achieving functionality and durability requires the use of a reverse total shoulder arthroplasty (TSA). This procedure has its own set of issues, namely, baseplate fixation and correction of glenoid medialization, if present. We present the case of an adult with achondroplastic dwarfism with shoulder osteoarthritis and rotator cuff insufficiency and report the 2-year clinical results for this patient after reverse TSA. Reverse TSA is a viable treatment option for adult achondroplastic patients with shoulder dysfunction. Careful preoperative planning is required to ensure a good clinical result in patients with potentially dysplastic anatomy.
软骨发育不全可导致多种骨骼表现，软骨发育不全患者可发生退行性骨关节炎。肱骨和肩胛盂形态改变——短肱骨伴干骺端增宽和肩胛盂内移——可带来挑战，在肩功能障碍患者中要取得成功的手术效果必须克服这些挑战。由于软骨发育不全患者的预期寿命接近正常，手术肩部必须长期具备功能且耐用。在患有肩部骨关节炎和肩袖功能不全的软骨发育不全侏儒患者中，实现功能和耐用性需要采用反式全肩关节置换术（TSA）。该手术有其自身的一系列问题，即基板固定以及如有肩胛盂内移则需进行矫正。我们报告一例患有肩部骨关节炎和肩袖功能不全的成年软骨发育不全侏儒患者的病例，并报告该患者接受反式TSA术后2年的临床结果。反式TSA是成年软骨发育不全性肩功能障碍患者的一种可行治疗选择。需要仔细的术前规划，以确保解剖结构可能发育异常的患者获得良好的临床结果。
