Stewart M P, Kelly I G
Royal Infirmary, Glasgow, Scotland, UK.
J Bone Joint Surg Br. 1997 Jan;79(1):68-72. doi: 10.1302/0301-620x.79b1.6645.
We made a prospective study of 58 consecutive Neer II total shoulder replacements in 49 rheumatoid patients. Cemented glenoid and press-fit humeral components had been used. After a mean follow-up of 9.5 years (7 to 13), 11 patients (15 shoulders) had died, one shoulder had been arthrodesed and five patients (five shoulders) had been lost to follow-up. Of the remaining 37 shoulders 29 were painfree or had only slight discomfort, four had pain on unusual activity, and four had moderate or severe pain. There were satisfactory improvements in the mean range of active elevation (53 degrees to 75 degrees) and external rotation (5 degrees to 38 degrees); satisfactory performance of the activities of daily living had been maintained throughout follow-up. Radiographs showed loosening in ten shoulders of nine glenoid and nine humeral components but of these only three had significant symptoms. Three loose glenoid components and two loose humeral components required revision. We consider that the Neer total shoulder replacement provides a reasonable medium to long-term outcome in rheumatoid arthritis, but recommend that the humeral component should be routinely cemented.
我们对49例类风湿性关节炎患者连续进行了58例Neer II型全肩关节置换术的前瞻性研究。采用了骨水泥固定的肩胛盂组件和压配式肱骨组件。平均随访9.5年（7至13年）后，11例患者（15个肩关节）死亡，1个肩关节已行关节融合术，5例患者（5个肩关节）失访。在其余37个肩关节中，29个无痛或仅有轻微不适，4个在异常活动时有疼痛，4个有中度或重度疼痛。主动抬高平均范围（从53度至75度）和外旋（从5度至38度）有令人满意的改善；在整个随访过程中，日常生活活动表现令人满意。X线片显示9个肩胛盂组件和9个肱骨组件中的10个肩关节出现松动，但其中只有3个有明显症状。3个松动的肩胛盂组件和2个松动的肱骨组件需要翻修。我们认为Neer全肩关节置换术在类风湿性关节炎中提供了合理的中长期疗效，但建议肱骨组件应常规采用骨水泥固定。
