Zeman C A, Arcand M A, Cantrell J S, Skedros J G, Burkhead W Z
Oxnard, California, USA.
J Am Acad Orthop Surg. 1998 Nov-Dec;6(6):337-48. doi: 10.5435/00124635-199811000-00002.
The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.
有症状的肩袖缺损性、关节炎性盂肱关节给骨科医生带来了一个复杂的问题。通过将该疾病归类于以下三种诊断类别之一，有助于手术治疗：(1) 肩袖撕裂性关节病；(2) 伴有肩袖缺损的类风湿性关节炎性肩关节；或 (3) 伴有肩袖缺损的退行性关节炎（骨关节炎）性肩关节。如果无法修复肩袖缺损，手术治疗可能包括人工关节置换术，但要认识到只能实现有限的目标，尤其是在力量和主动活动方面。当其他手术措施失败时，盂肱关节融合术是一种补救手术。三角肌缺损的患者也需要进行关节融合术。肱骨半关节置换术可避免肩胛盂松动的并发症，是关节融合术、切除性关节成形术和全肩关节置换术的一个有吸引力的替代方案。应保留功能完好的喙肩弓，以降低前上方半脱位的风险。应注意避免用假体部件 “过度填充” 盂肱关节。在存在明显内旋挛缩的情况下，需要延长肩胛下肌以恢复前后肩袖平衡。如果遵循Neer “有限目标” 康复的不太严格的标准，接受肱骨半关节置换术治疗的患者中约80% 至90% 可获得满意的结果。
