Sabzevari Soheil, Eads Ryan, Charles Shaquille, Reddy Rajiv P, Lin Albert
Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Orthopedic Surgery, Sports Medicine, Aptiva Health, Louisville, Kentucky, USA.
Video J Sports Med. 2023 Jan 12;3(1):26350254221140916. doi: 10.1177/26350254221140916. eCollection 2023 Jan-Feb.
Untreated chronic massive rotator cuff tears and primary osteoarthritis can lead to conditions of significant retroversion, posterior bone loss, and humeral head subluxation.
Reverse total shoulder arthroplasty with humeral head autograft glenoid reconstruction may be indicated in patients with advanced glenohumeral osteoarthritis and/or severe glenoid retroversion/bone loss due to rotator cuff arthropathy, trauma, primary, or inflammatory osteoarthritis.
Besides routine radiography and preoperative computed tomography (CT) scans, 3-dimensional (3D) planning software is often performed as a routine part of preoperative planning. A 3D printed model of the glenoid can also be helpful in cases of significant bone deformity. Patients are placed in a 45° modified beach chair position. Using a standard deltopectoral approach, the glenoid is exposed. An anatomic humeral head resection is made. The contour of the articular margin of the humeral head should match the glenoid bone deficiency anatomically as it has been chronically resting within the glenoid defect. Three dimensional preoperative planning and the 3D printed model are used to make an asymmetric humeral head autograft which should match the deficiency perfectly. The articular cartilage is removed with a burr. The graft and baseplate are coupled together (metaphyseal bone facing the baseplate and prepared articular side of the graft facing native bone) and measurements are performed with the preoperative planning software to fashion a graft with the appropriate dimension and with the desired amount of lateralization. The bone graft is then compressed with the baseplate to the native glenoid and fixed with screws.
In select patients with careful preoperative planning, excellent outcomes can be achieved with careful gradual resumption of range of motion and strength with physical therapy. Sequential radiographic imaging is performed up to 6 months and beyond to confirm solid union of graft to native glenoid bone and incorporation into the baseplate.
DISCUSSION/CONCLUSION: Reverse total shoulder arthroplasty (rTSA) with humeral head autograft glenoid reconstruction is an excellent option to address severe glenoid bone loss and restore the native joint line for both primary osteoarthritis and rotator cuff arthropathy. Using 3D CT scans, 3D preoperative planning software and 3D printing of the glenoid can help achieve a good outcome.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
未经治疗的慢性大面积肩袖撕裂和原发性骨关节炎可导致严重的后倾、后方骨质流失和肱骨头半脱位。
对于因肩袖关节病、创伤、原发性或炎性骨关节炎导致的晚期盂肱关节骨关节炎和/或严重的关节盂后倾/骨质流失患者，可考虑采用带自体肱骨头关节盂重建的反式全肩关节置换术。
除了常规的X线摄影和术前计算机断层扫描（CT）外，三维（3D）规划软件通常作为术前规划的常规部分。对于存在明显骨畸形的病例，3D打印的关节盂模型也可能有所帮助。患者置于45°改良沙滩椅位。采用标准的三角肌胸大肌入路暴露关节盂。进行解剖性肱骨头切除。肱骨头关节边缘的轮廓应在解剖学上与关节盂骨缺损相匹配，因为它长期位于关节盂缺损内。使用三维术前规划和3D打印模型制作不对称的自体肱骨头移植骨，使其与缺损完美匹配。用磨钻去除关节软骨。将移植骨与基板连接在一起（干骺端骨面向基板，移植骨准备好的关节面面向天然骨），并使用术前规划软件进行测量，以制作出尺寸合适且具有所需外展量的移植骨。然后将骨移植骨与基板一起压在天然关节盂上，并用螺钉固定。
在经过仔细术前规划的特定患者中，通过物理治疗谨慎逐步恢复活动范围和力量，可取得优异的效果。进行连续的影像学检查直至6个月及以后，以确认移植骨与天然关节盂骨牢固愈合并融入基板。
讨论/结论：带自体肱骨头关节盂重建的反式全肩关节置换术（rTSA）是解决严重关节盂骨质流失和恢复原发性骨关节炎和肩袖关节病天然关节线的极佳选择。使用3D CT扫描、3D术前规划软件和关节盂的3D打印有助于取得良好的效果。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者在本次提交发表的内容中包含了患者的豁免声明或其他书面形式的批准。
