Relationship Between Glenoid Component Shift and Osteolysis After Anatomic Total Shoulder Arthroplasty: Three-Dimensional Computed Tomography Analysis.
Relationship Between Glenoid Component Shift and Osteolysis After Anatomic Total Shoulder Arthroplasty: Three-Dimensional Computed Tomography Analysis.
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DOI：
10.2106/jbjs.20.00833
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发表时间：
2021-08-04
期刊：
影响因子：
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通讯作者：
Iannotti JP
中科院分区：
文献类型：
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作者：
Ricchetti ET;Jun BJ;Jin Y;Ho JC;Patterson TE;Dalton JE;Derwin KA;Iannotti JP
本研究的目的是使用连续三维计算机断层扫描（3D CT）分析评价解剖型全肩关节置换术（TSA）后的关节盂组件位置和射线可透性。在152例使用聚乙烯关节盂组件接受解剖型TSA的患者（Walch A1 42例、A2 16例、B1 7例、B2 49例、B3 29例、C1 3例、C2 3例和D关节盂）中，在术前（CT1）、术后早期（CT2）和至少2年随访（CT3）时进行了连续3D CT分析。关节盂组件移位定义为从CT 2到CT 3的组件版本或倾斜度变化≥3°。在CT 3时评估了关节盂组件中央锚钉骨质溶解（CPO）。对与关节盂组件移位和CPO相关的因素进行了评价。152例患者中有78例（51%）发生关节盂组件从CT 2移位至CT 3。152例患者中有19例（13%）在CT3时观察到CPO，包括78例组分移位患者中的15例（19%）。标准组件的Walch B2关节盂和术前后倾角较高的关节盂与较高的移位率相关，但与CPO无关。具有增强部件的B3关节盂和术前关节线内侧化更大的关节盂与CPO相关，但与移位无关。从CT2到CT3关节盂组件关节线内侧化越多，移位和CPO发生率越高。从CT 2到CT 3的关节盂组件倾斜度的绝对变化较大，以及从CT 2到CT 3的关节盂组件绝对旋转和倾斜度变化与CPO相关。关节盂组件移位或CPO均与较差的临床结局无关。术后3D CT分析表明，关节盂组件移位通常发生在解剖TSA之后，最常见的方向是倾斜度增加。大多数（81%）关节盂组件移位的患者未发生CPO。需要更长时间的随访来确定关节盂组件移位和CPO与随时间推移的松动之间的关系。治疗水平IV。有关证据等级的完整描述，请参见作者说明。
The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis. In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic TSA with a polyethylene glenoid component, sequential 3D CT analysis was performed preoperatively (CT1), early postoperatively (CT2), and at a minimum 2-year follow-up (CT3). Glenoid component shift was defined as a change in component version or inclination of ≥3° from CT2 to CT3. Glenoid component central anchor peg osteolysis (CPO) was assessed at CT3. Factors associated with glenoid component shift and CPO were evaluated. Glenoid component shift occurred from CT2 to CT3 in 78 (51%) of the 152 patients. CPO was seen at CT3 in 19 (13%) of the 152 patients, including 15 (19%) of the 78 with component shift. Walch B2 glenoids with a standard component and glenoids with higher preoperative retroversion were associated with a higher rate of shift, but not of CPO. B3 glenoids with an augmented component and glenoids with greater preoperative joint-line medialization were associated with CPO, but not with shift. More glenoid component joint-line medialization from CT2 to CT3 was associated with higher rates of shift and CPO. A greater absolute change in glenoid component inclination from CT2 to CT3 and a combined absolute glenoid component version and inclination change from CT2 to CT3 were associated with CPO. Neither glenoid component shift nor CPO was associated with worse clinical outcomes. Postoperative 3D CT analysis demonstrated that glenoid component shift commonly occurs following anatomic TSA, with increased inclination the most common direction. Most (81%) of the patients with glenoid component shift did not develop CPO. Longer follow-up is needed to determine the relationships of glenoid component shift and CPO with loosening over time. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.