非骨水泥型与骨水泥型反向全肩关节置换术联合背阔肌和大圆肌转移术
Uncemented vs. cemented reverse total shoulder arthroplasty with latissimus dorsi and teres major transfer.
作者信息
Matsuzawa Gaku, Hatta Taku, Sasajima Koichi, Itoi Eiji, Aizawa Toshitake
机构信息
Department of Orthopaedic Surgery, Tome Citizen Hospital, Tome, Japan.
Department of Orthopaedic Surgery, Iwaki City Medical Center, Iwaki, Japan.
出版信息
JSES Int. 2025 Jun 14;9(5):1731-1738. doi: 10.1016/j.jseint.2025.05.033. eCollection 2025 Sep.
BACKGROUND
Reverse total shoulder arthroplasty (rTSA) combined with latissimus dorsi and teres major (LD/TM) transfer is an effective treatment for massive rotator cuff tears associated with deficits in elevation and external rotation. The humeral components of rTSA can be implanted using either a cemented or uncemented technique; however, the impact of the fixation method on postoperative clinical outcomes remains unclear. The primary aim of this study was to compare the clinical outcomes of cemented or uncemented fixation of the humeral component in rTSA with LD/TM transfer with a minimum follow-up of 2 years. We hypothesized the fixation methods would influence the postoperative radiological findings but not the postoperative clinical outcomes.
METHODS
A total of 32 shoulders with rotator cuff tear and deficits in elevation and external rotation underwent rTSA with LD/TM transfer with either cemented (C group) or uncemented (unC group) humeral component. Postoperative clinical outcomes were evaluated based on the range of motion, the American Shoulder and Elbow Surgeons score, and the Constant-Murley score. Clinical and radiological outcomes were compared between the groups, and their progression over time was analyzed.
RESULTS
Both groups demonstrated significant postoperative improvements in range of motion, American Shoulder and Elbow Surgeons score, and Constant-Murley score, with no significant differences between the groups. However, bone resorption at the tendon insertion site was more prominent in the unC group than in the C group. Clinical outcomes stabilized after 6 months, and radiological findings showed no further changes beyond 12 months. No periprosthetic fractures were observed.
CONCLUSION
In patients treated with rTSA with LD/TM transfer, severe bone resorption at the tendon insertion site was more frequently observed in the patients treated with uncemented humeral implants than those with cemented ones.
背景
反向全肩关节置换术（rTSA）联合背阔肌和大圆肌（LD/TM）转移是治疗伴有上举和外旋功能障碍的巨大肩袖撕裂的有效方法。rTSA的肱骨组件可采用骨水泥固定或非骨水泥固定技术植入；然而，固定方法对术后临床结果的影响尚不清楚。本研究的主要目的是比较rTSA联合LD/TM转移时，肱骨组件采用骨水泥固定或非骨水泥固定的临床结果，随访至少2年。我们假设固定方法会影响术后影像学表现，但不会影响术后临床结果。
方法
共有32例肩袖撕裂且伴有上举和外旋功能障碍的患者接受了rTSA联合LD/TM转移术，肱骨组件分别采用骨水泥固定（C组）或非骨水泥固定（unC组）。根据活动范围、美国肩肘外科医生评分和Constant-Murley评分评估术后临床结果。比较两组的临床和影像学结果，并分析其随时间的变化。
结果
两组术后在活动范围、美国肩肘外科医生评分和Constant-Murley评分方面均有显著改善，两组间无显著差异。然而，unC组肌腱附着部位的骨吸收比C组更明显。临床结果在6个月后稳定，影像学表现12个月后无进一步变化。未观察到假体周围骨折。
结论
在接受rTSA联合LD/TM转移术治疗的患者中，与采用骨水泥固定肱骨假体的患者相比，采用非骨水泥固定肱骨假体的患者更常观察到肌腱附着部位的严重骨吸收。
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