Nakazawa Katsumasa, Manaka Tomoya, Minoda Yukihide, Hirakawa Yoshihiro, Ito Yoichi, Shimizu Hayato, Iio Ryosuke, Nishiura Rei, Terai Hidetomi
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Ishikiriseiki Hospital, Higashiosaka, Japan.
Arch Orthop Trauma Surg. 2025 Jul 30;145(1):391. doi: 10.1007/s00402-025-05981-y.
Humeral lengthening (HL) has been reported to correlate with post-operative clinical outcomes of reverse shoulder arthroplasty (RSA). However, these are simple radiographic evaluations, and three-dimensional (3D) assessments using computed tomography (CT) images have not been considered. This study aimed to investigate the factors that influence post-operative clinical outcomes of RSA implant placement using a 3D evaluation system, specifically, the effect of HL on post-operative clinical outcomes.
This retrospective study included 49 patients who underwent RSA using the Exactech Equinoxe Reverse Shoulder System (Exactech Inc., Gainesville, FL, USA) for cuff tear arthropathy or irreparable rotator cuff tear between August 2017 and June 2021 and were followed up for at least two years post-operatively. An augmented baseplate was used in 19 patients. Pre- and post-operative CT images were used to evaluate post-operative implant placement using the 3D planning software ZedShoulder software (Lexi, Tokyo, Japan). Global offset, overhang of glenosphere, glenoid version, glenoid inclination, HL, and amount of humeral resection were measured. Clinical outcomes were also evaluated in relation to post-operative implant placement.
Univariate analysis revealed that HL correlated with the pain score of Constant-Murley score and visual analog scale (VAS) (r=-0.37, p = 0.01; r = 0.38, p = 0.01). Moreover, the overhang of the glenosphere correlated with the Constant-Murley score and the pain score of the Constant-Murley score (r=-0.34, p = 0.02; r = 0.31, p = 0.03). Using multivariate analysis, HL and the overhang of the glenosphere were factors influencing the pain score on the Constant-Murley score (R = 0.502). Allocating patients with HL into two groups based on the amount of lengthening (≤ 18 mm and > 18 mm), the pain score of the Constant-Murley score and pain VAS were significantly lower in the group with HL of ≤ 18 mm (p < 0.01, p < 0.01).
HL affected post-operative pain scores in patients undergoing RSA. Particularly, the group with HL of ≤ 18 mm had a significantly lower pain score. Therefore, we suggest that post-operative pain scores could be improved by reducing the HL to ≤ 18 mm. However, this was a retrospective study with a small number of cases, and the correlation between HL and outcomes requires further investigation.
据报道，肱骨延长术（HL）与反肩关节置换术（RSA）的术后临床结果相关。然而，这些都是简单的影像学评估，尚未考虑使用计算机断层扫描（CT）图像进行三维（3D）评估。本研究旨在使用3D评估系统调查影响RSA植入物放置术后临床结果的因素，具体而言，是HL对术后临床结果的影响。
本回顾性研究纳入了49例在2017年8月至2021年6月期间因肩袖撕裂性关节病或不可修复的肩袖撕裂而使用Exactech Equinoxe反肩关节系统（美国佛罗里达州盖恩斯维尔的Exactech公司）进行RSA手术且术后至少随访两年的患者。19例患者使用了增强型基板。术前和术后的CT图像用于使用3D规划软件ZedShoulder软件（日本东京的Lexi）评估术后植入物的放置情况。测量了整体偏移、关节盂球头的悬垂、关节盂角度、关节盂倾斜度、HL以及肱骨切除量。还评估了与术后植入物放置相关的临床结果。
单因素分析显示，HL与Constant-Murley评分的疼痛评分和视觉模拟量表（VAS）相关（r=-0.37，p = 0.01；r = 0.38，p = 0.01）。此外，关节盂球头的悬垂与Constant-Murley评分以及Constant-Murley评分的疼痛评分相关（r=-0.34，p = 0.
