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应对反肩关节置换术中活动范围的复杂性:创新与未来方向

Navigating the Complexities of Range of Motion in Reverse Shoulder Arthroplasty: Innovations and Future Directions.

作者信息

Bailey Karsyn N, Aleem Alexander W

机构信息

Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.

出版信息

Curr Rev Musculoskelet Med. 2025 Mar;18(3):94-101. doi: 10.1007/s12178-024-09943-6. Epub 2025 Jan 8.

Abstract

PURPOSE OF REVIEW

With the growing popularity and broadening indications for Reverse Shoulder Arthroplasty (RSA), increasing modularity in design and adjustments to each component can enhance postoperative range of motion (ROM), thus expanding treatment capabilities. This review outlines the advancements developed to optimize ROM through modifications in glenoid and humeral components and the integration of computational tools for surgical planning.

RECENT FINDINGS

Enhancements in glenoid component design aim to mitigate complications like scapular notching and improve ROM, particularly in abduction and external rotation. Modifications to the humeral component, including adjustments in neck-shaft angle and lateralization, also contribute to ROM optimization. The integration of computational modeling and intraoperative navigation is advancing towards a more tailored approach to RSA to increase postoperative ROM. While RSA has evolved considerably since the introduction of the Grammont prosthesis, current research continues to improve upon implant design and positioning to overcome early design limitations. Modifications such as glenoid lateralization and inferior positioning and humeral neck-shaft angle and lateralization contribute to better postoperative ROM. The integration of these advancements in implant adjustments with computational modeling for surgical planning has the potential to enhance ROM and patient-specific outcomes. Translating these biomechanical improvements into clinical benefit remains a key area for future investigation.

摘要

综述目的

随着反肩关节置换术(RSA)的日益普及和适应证的不断拓宽,设计中模块化程度的提高以及对每个组件的调整可以增加术后活动范围(ROM),从而扩大治疗能力。本综述概述了通过改良盂肱组件以及整合用于手术规划的计算工具来优化ROM所取得的进展。

最新发现

盂肱组件设计的改进旨在减轻诸如肩胛切迹等并发症并改善ROM,尤其是在外展和外旋方面。肱骨头组件的改良,包括颈干角和侧方化的调整,也有助于ROM的优化。计算建模和术中导航的整合正朝着更个性化的RSA方法发展,以增加术后ROM。自Grammont假体引入以来,RSA已经有了很大的发展,当前的研究仍在继续改进植入物的设计和定位,以克服早期设计的局限性。诸如盂肱侧方化和下方定位以及肱骨头颈干角和侧方化等改良有助于术后获得更好的ROM。将这些植入物调整方面的进展与用于手术规划的计算建模相结合,有可能提高ROM并改善针对患者的治疗效果。将这些生物力学方面的改进转化为临床益处仍然是未来研究的一个关键领域。

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