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反式肩关节置换术后的肩胛盂切迹:不同颈干角的影响。

Glenoid notching after reverse shoulder arthroplasty: The influence of different neck-shaft angles.

作者信息

Pereira Catarina, Carrapatoso Manuel, Barros Luís H, Claro Rui

机构信息

Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.

出版信息

Shoulder Elbow. 2024 Jul 25:17585732241262524. doi: 10.1177/17585732241262524.

Abstract

BACKGROUND

The implications of notching in reverse shoulder arthroplasty (RSA), and its relation with the rate of complications are still unclear. Our main aim was to retrospectively study the notching incidence in the three most used implants in our practice, considering their different neck-shaft angle (NSA) and determine its relation with implant failure, or other complications.

METHODS

We retrospectively reviewed medical and imaging records of 259 patients who underwent RSA in our hospital, including surgery reports, prosthesis designs and techniques. We assessed all radiographs taken during the follow up to evaluate notching incidence, progression and signs of failure.

RESULTS

Notching occurred in 35% cases. The average time to notch development was 19 months. Implants with a lower NSA showed significantly lower incidence of notching when compared to other implants ( < 0.001). In a multivariate analysis, the NSA proved to be an independent predictor for the occurrence of notching in this series.

DISCUSSION

According to our results, higher NSA is an independent predictor of the occurrence of notching. There was significant increase in the notching rate with follow up. In the future, larger case series with longer follow-up are necessary to evaluate the relation between notching and radiological and clinical complications.

摘要

背景

在反肩关节置换术(RSA)中,骨切迹的影响及其与并发症发生率的关系仍不明确。我们的主要目的是回顾性研究我们临床实践中最常用的三种植入物的骨切迹发生率,考虑它们不同的颈干角(NSA),并确定其与植入物失败或其他并发症的关系。

方法

我们回顾性分析了我院259例行RSA患者的医疗和影像记录,包括手术报告、假体设计和技术。我们评估了随访期间拍摄的所有X线片,以评估骨切迹发生率、进展情况和失败迹象。

结果

35%的病例出现骨切迹。骨切迹出现的平均时间为19个月。与其他植入物相比,NSA较低的植入物骨切迹发生率显著较低(<0.001)。在多变量分析中,NSA被证明是该系列中骨切迹发生的独立预测因素。

讨论

根据我们的结果,较高的NSA是骨切迹发生的独立预测因素。随访期间骨切迹发生率显著增加。未来,需要更大规模、更长随访时间的病例系列来评估骨切迹与放射学和临床并发症之间的关系。

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本文引用的文献

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Inlay versus onlay humeral design for reverse shoulder arthroplasty: a systematic review and meta-analysis.
J Shoulder Elbow Surg. 2022 Nov;31(11):2410-2420. doi: 10.1016/j.jse.2022.05.002. Epub 2022 Jun 4.
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Reverse Shoulder Arthroplasty for Proximal Humerus Fracture.
Curr Rev Musculoskelet Med. 2020 Apr;13(2):186-199. doi: 10.1007/s12178-020-09597-0.
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Classifications in Brief: The Nerot-Sirveaux Classification for Scapular Notching.
Clin Orthop Relat Res. 2018 Dec;476(12):2454-2457. doi: 10.1097/CORR.0000000000000442.
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Previous Rotator Cuff Repair Is Associated With Inferior Clinical Outcomes After Reverse Total Shoulder Arthroplasty.
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Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders.
J Shoulder Elbow Surg. 2017 Jul;26(7):1253-1261. doi: 10.1016/j.jse.2016.11.043. Epub 2017 Jan 19.
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The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review.
J Shoulder Elbow Surg. 2015 Jun;24(6):988-93. doi: 10.1016/j.jse.2015.01.001. Epub 2015 Feb 26.
9
Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty.
Clin Orthop Relat Res. 2014 Sep;472(9):2809-15. doi: 10.1007/s11999-014-3696-5. Epub 2014 Jun 7.
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Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up.
J Shoulder Elbow Surg. 2014 Aug;23(8):1208-14. doi: 10.1016/j.jse.2013.11.032. Epub 2014 Feb 20.

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