Quemener Alexandre, Dabert Alizé, Rochet Séverin, Antoine Adam, Pozet Astrid, Nourissat Geoffroy, Antoni Maxime, Harris Howard, Agu Chinyelum, van Rooij Floris, Obert Laurent
University of Franche Comte, Medical School & University Hospital Besançon, SINERGIES, Besançon, France.
CHU de Besançon, Delegation for Clinical Research and Innovation, Besançon, France.
J Shoulder Elb Arthroplast. 2024 Oct 17;8:24715492241291315. doi: 10.1177/24715492241291315. eCollection 2024.
To compare outcomes, between stemmed and stemless reverse shoulder arthroplasty (RSA) at a minimum follow-up of 5 years.
The authors retrospectively assessed a consecutive series of 45 patients that underwent RSA between September 2014 and October 2018 (23 stemless and 22 stemmed). All patients underwent plain anteroposterior and scapular Y-view radiographs for assessment immediately post-operatively and at final follow-up. At a minimum follow-up of 5 years, an independent observer assessed the clinical scores, including Constant score, QuickDASH score, and American Shoulder and Elbow Surgeons score.
Of the 45 patients that underwent RSA, 5 patients died (11%), 2 were revised due to infection (4%), and 4 patients were lost to follow-up (9%). This left a final cohort of 34 patients (18 stemless and 16 stemmed). Significant differences between groups were found immediately post-operatively for lateralisation shoulder angle (LSA) (p = 0.021), but at 5 years post-operative for distalisation shoulder angle (DSA) (p = 0.017) and QuickDASH scores (p = 0.041) (Table 4), while the outcomes were comparable for absolute Constant scores, ASES score, and range of motion. Finally, stemless RSA had a 17% complication rate, while stemmed RSA had a 31% complication rate.
Stemless RSA had significantly more lateralisation, and significantly less distalisation, compared to stemmed RSA. Furthermore, at a 5-year follow-up, stemless RSA granted significantly greater QuickDASH scores. Finally, stemless RSA had comparable complication rates as stemmed RSA. The clinical relevance of this study is that stemless RSA is a safe alternative to stemmed RSA, while granting comparable or greater scores. III, Comparative Study.
比较柄式和无柄反肩关节置换术（RSA）在至少5年随访期后的疗效。
作者回顾性评估了2014年9月至2018年10月期间连续接受RSA手术的45例患者（23例无柄和22例有柄）。所有患者在术后即刻和最终随访时均接受了前后位和肩胛Y位X线平片评估。在至少5年的随访期后，由一名独立观察者评估临床评分，包括Constant评分、QuickDASH评分和美国肩肘外科医师协会评分。
在接受RSA手术的45例患者中，5例死亡（11%），2例因感染进行了翻修（4%），4例失访（9%）。最终纳入34例患者（18例无柄和16例有柄）。术后即刻两组间在肩关节外展角（LSA）上存在显著差异（p = 0.021），但在术后5年时，在肩关节下移角（DSA）（p = 0.017）和QuickDASH评分（p = 0.041）上存在显著差异（表4），而绝对Constant评分、ASES评分和活动范围的结果相当。最后，无柄RSA的并发症发生率为17%，而有柄RSA的并发症发生率为31%。
与有柄RSA相比，无柄RSA的外展明显更多，下移明显更少。此外，在5年随访时，无柄RSA的QuickDASH评分显著更高。最后，无柄RSA与有柄RSA的并发症发生率相当。本研究的临床意义在于，无柄RSA是有柄RSA的一种安全替代方案，同时评分相当或更高。III级，比较研究。
