Stepped Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for B2 and B3 Glenoid Pathology: A Study of Early Outcomes.
Stepped Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for B2 and B3 Glenoid Pathology: A Study of Early Outcomes.
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DOI：
10.2106/jbjs.20.01420
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发表时间：
2021-10-06
期刊：
影响因子：
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通讯作者：
Ricchetti ET
中科院分区：
文献类型：
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作者：
Iannotti JP;Jun BJ;Derwin KA;Ricchetti ET
后关节盂骨丢失通常与原发性盂肱骨关节炎有关。解剖型全肩关节置换术（aTSA）中骨丢失的手术治疗仍然存在争议。我们研究了使用阶梯式增强型关节盂组件来管理 Walch B2 和 B3 关节盂，并将短期随访时的放射学和临床结果与 Walch A1 关节盂中相同设计的非增强型组件所取得的结果进行了比较。 92 名患者（42 名 A1、29 名 B2 和 21 名 B3 关节盂）在 aTSA 后进行了前瞻性随访。术前、术后 3 个月内使用金属伪影减少 (MAR) 进行连续 3 维 (3D) 计算机断层扫描 (CT) 成像以确定种植体位置，并在术后至少 2 年使用 MAR。肩胛骨 3D 配准与种植体配准可以对关节盂种植体位置、种植体移位和中央钉骨质溶解 (CPO) 进行 3D 测量。使用增强关节盂组件治疗的 B3 关节盂 (29%) 发生伴或不伴种植体移位的 CPO 的比例高于使用标准组件治疗的 A1 关节盂 (5%) (p = 0.028)。具有增强组件 (10%) 的 B2 关节盂和具有标准组件的 A1 关节盂之间的 CPO 频率没有显着差异。组间术后关节盂组件版本和倾斜度没有差异。与 A1 和 B2 关节盂相比，相对于病前关节线，B3 关节盂与更多的组件内侧化相关 (p < 0.001)。阶梯式增强型关节盂组件可以恢复不对称双凹关节盂骨丢失 (Walch B2) 患者的病前关节盂解剖结构，其短期临床和影像学结果与使用非增强型组件治疗的无关节盂骨丢失 (Walch A1) 的患者相当。对于患有中度至重度 B3 关节盂病理且采用这种阶梯式增强关节盂组件的患者，发生 CPO 的风险更大。更长的随访时间将有助于确定 CPO 随着时间的推移的临床影响。治疗级别 II。有关证据级别的完整描述，请参阅作者须知。
Posterior glenoid bone loss is commonly associated with primary glenohumeral osteoarthritis. Surgical management of bone loss in anatomic total shoulder arthroplasty (aTSA) remains controversial. We studied the use of a stepped augmented glenoid component for management of Walch B2 and B3 glenoids and compared the radiographic and clinical outcomes at short-term follow-up with those achieved with a non-augmented component of the same design in Walch A1 glenoids. Ninety-two patients (42 A1, 29 B2, and 21 B3 glenoids) were prospectively followed after aTSA. Sequential 3-dimensional (3D) computed tomography (CT) imaging was performed preoperatively, within 3 months postoperatively with metal artifact reduction (MAR) to define implant position, and at a minimum of 2 years postoperatively with MAR. Scapular 3D registration with implant registration allowed 3D measurement of glenoid implant position, implant shift, and central peg osteolysis (CPO). CPO with or without implant shift occurred in a higher percentage of B3 glenoids treated with the augmented glenoid component (29%) than A1 glenoids treated with a standard component (5%) (p = 0.028). There was no significant difference in the frequency of CPO between B2 glenoids with the augmented component (10%) and A1 glenoids with the standard component. There was no difference in postoperative glenoid component version and inclination between groups. B3 glenoids were associated with more component medialization relative to the premorbid joint line compared with A1 and B2 glenoids (p < 0.001). A stepped augmented glenoid component can restore premorbid glenoid anatomy in patients with asymmetric biconcave glenoid bone loss (Walch B2), with short-term clinical and radiographic results equivalent to those for patients without glenoid bone loss (Walch A1) treated with a non-augmented component. There is a greater risk of CPO in patients with moderate-to-severe B3 glenoid pathology with this stepped augmented glenoid component. Longer follow-up will help define the clinical implications of CPO over time. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.