Sneppen O, Fruensgaard S, Johannsen H V, Olsen B S, Sojbjerg J O, Andersen N H
Orthopaedic Department E University Hospital, Aarhus, Denmark.
J Shoulder Elbow Surg. 1996 Jan-Feb;5(1):47-52. doi: 10.1016/s1058-2746(96)80030-9.
A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal migration of the humerus before surgery was performed. The mean follow-up time was 92 months (range 52 to 139 months). The results revealed proximal migration in 55% of the patients (34 shoulders), and 40% (25 shoulders) showed progressive radiographic loosening of the glenoid component. Five of 12 press-fit humeral components demonstrated progressive radiographic loosening, whereas no signs of loosening were found in 50 cemented humeral components. In spite of progressive component loosening and progressive migration, this study demonstrated good pain relief in 89% of the patients (55 shoulders) and also a significant improvement in range of movement and function. The presence of proximal humeral migration did not significantly influence the average results-neither pain relief, range of movement, abduction force, nor function. Also, component loosening did not significantly influence the average pain relief, range of movement, abduction force, or function. The risk of clinical asymptomatic loosening is a relatively late complication that is eventually followed by pronounced bone destruction related to the loose component. Long-term radiographic control of total shoulders with rheumatoid arthritis is recommended. Hemiarthroplasty with a cemented humeral prosthesis may be a better treatment in the end stage of rheumatoid arthritis of the shoulder.
对1981年至1990年期间为51例类风湿性关节炎患者实施的62例NeerⅡ型全肩关节置换术进行了一项前瞻性研究，以评估与假体松动和肱骨近端移位相关的因素。32例（51%）在手术前出现肱骨近端移位。平均随访时间为92个月（范围52至139个月）。结果显示，55%的患者（34个肩关节）出现近端移位，40%（25个肩关节）显示肩胛盂假体有进行性影像学松动。12个压配式肱骨假体中有5个出现进行性影像学松动，而50个骨水泥固定的肱骨假体未发现松动迹象。尽管假体出现进行性松动和进行性移位，但本研究显示89%的患者（55个肩关节）疼痛得到良好缓解，活动范围和功能也有显著改善。肱骨近端移位的存在对平均结果没有显著影响——无论是疼痛缓解、活动范围、外展力还是功能。同样，假体松动对平均疼痛缓解、活动范围、外展力或功能也没有显著影响。临床无症状松动的风险是一种相对较晚出现的并发症，最终会导致与松动假体相关的明显骨质破坏。建议对类风湿性关节炎全肩关节置换术进行长期影像学监测。对于肩部类风湿性关节炎终末期，采用骨水泥固定肱骨假体的半关节置换术可能是一种更好的治疗方法。
