Lim Joon-Ryul, Do Woo-Sung, Chang Hsien-Hao, Yoon Tae-Hwan, Chun Yong-Min
Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Sci Rep. 2024 Dec 30;14(1):31587. doi: 10.1038/s41598-024-79669-5.
The humeral head is the second most common anatomical site of osteonecrosis after the femoral head. Studies have reported satisfactory clinical outcomes after shoulder arthroplasty to treat osteonecrosis of the humeral head (ONHH). However, there are concerns regarding implant longevity in relatively young patients. This study investigated the effectiveness of non-operative treatment for atraumatic ONHH in relatively young patients. Thirty-two patients (41 shoulders, 9 bilateral) were included and received non-operative ONHH treatment consisting of pain management and self-stretching exercises. Treatment failure was defined as conversion to surgical treatment owing to difficulty performing activities of daily living with resting pain (Visual Analog Scale [VAS] ≥ 6) after 6 months of staged treatment. The mean follow-up was 73.6 months. The mean ONHH stage was 3.6 initially and 3.8 at final follow-up. Stage progression was observed in 14.6% (6/41) of the shoulders. No treatment failures occurred during follow-up. Between the initial visit and final follow-up, no significant differences in clinical outcomes, including resting pain, Single Assessment Numeric Evaluation score, forward flexion, and external rotation were observed; only internal rotation range of motion was observed to significantly decrease (p < 0.001). Non-operative treatment showed satisfactory results in relatively young patients with advanced atraumatic ONHH.
肱骨头是继股骨头之后第二常见的骨坏死解剖部位。研究报告称，肩关节置换术治疗肱骨头骨坏死（ONHH）后临床效果令人满意。然而，对于相对年轻的患者，人工关节的使用寿命存在担忧。本研究调查了相对年轻患者非创伤性ONHH的非手术治疗效果。纳入32例患者（41个肩关节，9例双侧），接受包括疼痛管理和自我伸展锻炼的非手术ONHH治疗。治疗失败定义为在分阶段治疗6个月后，因静息痛（视觉模拟评分[VAS]≥6）导致日常生活活动困难而转为手术治疗。平均随访73.6个月。ONHH的平均初始分期为3.6期，末次随访时为3.8期。14.6%（6/41）的肩关节观察到分期进展。随访期间未发生治疗失败。在初次就诊和末次随访之间，静息痛、单项评估数字评价评分、前屈和外旋等临床结果无显著差异；仅内旋活动范围显著减小（p<0.001）。非手术治疗在相对年轻的晚期非创伤性ONHH患者中显示出令人满意的结果。
