Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency
Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency
复制标题
DOI：
10.2106/jbjs.g.00775
复制
发表时间：
2008-06-01
影响因子：
5.3
通讯作者：
Frankle, Mark
中科院分区：
文献类型：
--
作者：
Cuff, Derek;Pupello, Derek;Frankle, Mark
背景：用于治疗与严重肩袖缺陷相关的盂肱关节炎的反向肩关节成形术组件的早期设计在某些情况下与机械故障有关。本研究的目的是对使用 5.0 毫米周边锁定螺钉进行基板固定和侧向旋转中心治疗肩袖缺陷的反向肩关节置换术进行前瞻性结果研究。方法：从 2004 年 2 月到 2005 年 3 月，作为美国食品和药物管理局研究器械豁免的一部分，112 名患者（114 肩）接受了反向肩关节置换术的治疗研究。九十四名患者（九十六个肩膀）可以进行至少两年的随访。在 96 个肩部中，37 个肩部患有原发性肩袖缺陷，33 个肩部之前接受过肩袖手术，23 个肩部之前接受过关节置换术，3 个肩部患有近端肱骨不愈合。对患者进行前瞻性临床随访（美国肩肘外科医生 [ASES] 评分、简单肩部测试 [SST] 和自我报告的满意度）和放射学检查（机械故障、松动和缺口）。在治疗前后执行标准主动活动范围方案时对患者进行录像。然后，三名独立观察者使用数字测角仪以盲法方式对这些视频进行分析。结果：两年后，平均 ASES 总分从术前的 30 分提高到 77.6 分；平均 ASES 疼痛评分，从 15 到 41.6；平均 SST 分数从 1.8 到 6.8（全部 p < 0.0001）。活动范围的盲分析表明，平均外展从术前的 61 度改善至 109.5 度（p < 0.0001）；平均屈曲度，从 63.5 度到 118 度 (p < 0.0001)；平均外旋角从 13.4 度到 28.2 度 (p < 0.0001)。患者对 53 个肩膀（55%）的结果评价为优秀，对 26 个肩膀（27%）评价为良好，对 11 个肩膀评价满意（12%），对 6 个肩膀评价不满意（6%）。没有证据表明任何患者的底板或肩胛切迹出现机械故障。本研究中的 94 名患者中有 6 名出现并发症。结论：反向肩关节置换术的最新进展改善了患者的预后，同时最大限度地减少了早期机械故障和肩胛骨切迹，并降低了短期随访的总体并发症发生率。证据级别：治疗级别 IV。有关证据级别的完整描述，请参阅作者须知。
Background: Early designs of reverse shoulder arthroplasty components for the treatment of glenohumeral arthritis associated with severe rotator cuff deficiency in some cases have been associated with mechanical failure. The purpose of this study was to perform a prospective outcomes study of reverse shoulder arthroplasty performed with use of 5.0-mm peripheral locking screws for baseplate fixation and a lateralized center of rotation for the treatment of a rotator cuff deficiency.Methods: From February 2004 to March 2005, 112 patients (114 shoulders) were treated with a reverse shoulder arthroplasty as part of a United States Food and Drug Administration Investigational Device Exemption study. Ninety-four patients (ninety-six shoulders) were available for a minimum follow-up of two years. Of the ninety-six shoulders, thirty-seven had a primary rotator cuff deficiency, thirty-three had a previous rotator cuff operation, twenty-three had a previous arthroplasty, and three had a proximal humeral nonunion. The patients were prospectively followed clinically (the American Shoulder and Elbow Surgeons [ASES] score, the Simple Shoulder Test [SST], and self-reported satisfaction) and radiographically (mechanical failure, loosening, and notching). Patients were videotaped while performing a standard active range-of-motion protocol before and after treatment. These videos were then analyzed in a blinded fashion by three independent observers using a digital goniometer.Results: At two years, the average total ASES scores had improved from 30 preoperatively to 77.6; the average ASES pain scores, from 15 to 41.6; and the average SST scores, from 1.8 to 6.8 (p < 0.0001 for all). Blinded analysis of range of motion showed that average abduction improved from 61 degrees preoperatively to 109.5 degrees (p < 0.0001); average flexion, from 63.5 degrees to 118 degrees (p < 0.0001); and average external rotation, from 13.4 degrees to 28.2 degrees (p < 0.0001). The patients rated the outcome as excellent in fifty-three shoulders (55%), good in twenty-six (27%), satisfactory in eleven (12%), and unsatisfactory in six (6%). There was no evidence of mechanical failure of the baseplate or scapular notching in any of the patients. Six of the ninety-four patients in this study had a complication.Conclusions: Recent advances in reverse shoulder arthroplasty have allowed for improvement in patient outcomes while minimizing early mechanical failure and scapular notching and decreasing the overall complication rate at short-term follow-up.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.