Huber H M, Gschwend N
Klinik Wilhelm Schulthess, Zürich.
Z Orthop Ihre Grenzgeb. 1993 Jan-Feb;131(1):18-21. doi: 10.1055/s-2008-1039898.
Due to severe articular destruction of the glenohumeral joint with corresponding soft tissue changes arthrodesis has been performed in 24 patients since 1973. After an average period of 5.4 years (2-15) years, 22 patients were reviewed. Primary bone consolidation was achieved in all cases. During the observation period in 7 cases one of the following additional operations had to be performed on the involved shoulder: subcapital osteotomy due to excessive abduction (2 cases), resection of the acromio-clavicular joint due to painful osteoarthritis (2 cases), partial resection of an ugly acromion projecting laterally (1 case), removal of the fixation plate protruding proximally (4 cases). 18 patients experienced a marked improvement after arthrodesis. No improvement in 2 cases and a deterioration in 2 cases were the result of a not optimal positioning of the arthrodesis. A position of 20 of abduction, 20 to 30 of flexion and 45 of internal rotation proved to be functionally the most beneficial. Patients will be only painless if the optimal position of the arthrodesis was achieved. Excessive abduction and flexion was generally experienced as unpleasant. Deviation in the rotational position leads to functional restriction. The remaining function after arthrodesis is often overrated.
自1973年以来，由于肩肱关节严重的关节破坏以及相应的软组织改变，已对24例患者实施了关节固定术。平均5.4年（2 - 15年）后，对22例患者进行了复查。所有病例均实现了一期骨愈合。在观察期内，7例患者受累肩部不得不进行以下附加手术之一：因外展过度行股骨头下截骨术（2例），因疼痛性骨关节炎行肩锁关节切除术（2例），部分切除向外突出的难看肩峰（1例），取出向近端突出的固定钢板（4例）。18例患者在关节固定术后有明显改善。2例无改善以及2例病情恶化是关节固定术定位不佳的结果。外展20°、屈曲20°至30°以及内旋45°的位置在功能上被证明是最有益的。只有当关节固定术达到最佳位置时患者才会无痛。外展和屈曲过度通常会让人感觉不适。旋转位置的偏差会导致功能受限。关节固定术后剩余的功能常常被高估。
