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Abstract：
Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management.
To determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up.
Case series; Level of evidence, 3.
The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery and otherwise met criteria for total shoulder arthroplasty. At minimum 10-year follow-up, postoperative outcome measures included change in the American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey (SF-12) Physical Component Summary, and visual analog scale for pain, along with the QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) and satisfaction score. Kaplan-Meier survivorship analysis was performed, with failure defined as progression to arthroplasty.
In total, 38 CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean patient age of 53 years (range, 27-68 years) at the time of surgery. Survivorship was 75.3% at 5 years and 63.2% at minimum 10 years. Those who progressed to arthroplasty did so at a mean 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, American Shoulder and Elbow Surgeons scores significantly improved postoperatively at 5 years (63.3 to 89.6; P < .001) and 10 years (63.3 to 80.6; P = .007). CAM failure was associated with severe preoperative humeral head incongruity in 93.8% of failures as compared with 50.0% of patients who did not go on to arthroplasty (P = .008). Median satisfaction was 7.5 out of 10.
Significant improvements in patient-reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. The survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint-preserving treatment for GHOA in appropriately selected patients, with sustained positive outcomes at 10 years.
To determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up.
Case series; Level of evidence, 3.
The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery and otherwise met criteria for total shoulder arthroplasty. At minimum 10-year follow-up, postoperative outcome measures included change in the American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey (SF-12) Physical Component Summary, and visual analog scale for pain, along with the QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) and satisfaction score. Kaplan-Meier survivorship analysis was performed, with failure defined as progression to arthroplasty.
In total, 38 CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean patient age of 53 years (range, 27-68 years) at the time of surgery. Survivorship was 75.3% at 5 years and 63.2% at minimum 10 years. Those who progressed to arthroplasty did so at a mean 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, American Shoulder and Elbow Surgeons scores significantly improved postoperatively at 5 years (63.3 to 89.6; P < .001) and 10 years (63.3 to 80.6; P = .007). CAM failure was associated with severe preoperative humeral head incongruity in 93.8% of failures as compared with 50.0% of patients who did not go on to arthroplasty (P = .008). Median satisfaction was 7.5 out of 10.
Significant improvements in patient-reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. The survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint-preserving treatment for GHOA in appropriately selected patients, with sustained positive outcomes at 10 years.
摘要：
很少有长期结果研究评估关节镜治疗的肱骨骨关节炎（GHOA）。
为了确定结果，失败的风险因素，在至少10年的随访中，对GHOA的综合关节镜管理（CAM）程序进行了生存。
案例系列；证据水平，3.
对一系列选择关节保留手术并符合全肩关节置换术标准的晚期GHOA患者进行了CAM手术。至少10年随访,术后结局指标包括美国肩肘外科医师的改变，单一评估数字评估，12项简式健康调查(SF-12)物理组件摘要，和疼痛的视觉模拟量表，连同QuickDASH（手臂残疾的缩短版本，肩和手）和满意度得分。进行了Kaplan-Meier生存分析，失败定义为进展为关节成形术。
总共，进行了38次CAM手术，并进行了10年的最低随访（范围，10-14岁)，患者平均年龄为53岁(范围，27-68岁）在手术时。5年生存率为75.3％，至少10年生存率为63.2％。那些进展为关节成形术的人平均为4.7年(范围，0.8-9.6年）。对于那些没有接受关节置换术的人，术后5年（63.3至89.6；P<.001）和10年（63.3至80.6；P=.007），美国肩肘外科医生的评分显着提高。在93.8％的失败患者中，CAM失败与严重的术前肱骨头不协调相关，而未进行关节成形术的患者为50.0％（P=.008）。满意度中位数为10分之7.5。
接受CAM手术的年轻GHOA患者在至少10年的随访中，患者报告的预后得到了显著改善。最低10年随访生存率为63.2%。肱骨头扁平和严重的关节不协调是CAM失败的危险因素。在适当选择的患者中，CAM程序是GHOA的有效关节保留治疗，在10年内取得持续的积极成果。
为了确定结果，失败的风险因素，在至少10年的随访中，对GHOA的综合关节镜管理（CAM）程序进行了生存。
案例系列；证据水平，3.
对一系列选择关节保留手术并符合全肩关节置换术标准的晚期GHOA患者进行了CAM手术。至少10年随访,术后结局指标包括美国肩肘外科医师的改变，单一评估数字评估，12项简式健康调查(SF-12)物理组件摘要，和疼痛的视觉模拟量表，连同QuickDASH（手臂残疾的缩短版本，肩和手）和满意度得分。进行了Kaplan-Meier生存分析，失败定义为进展为关节成形术。
总共，进行了38次CAM手术，并进行了10年的最低随访（范围，10-14岁)，患者平均年龄为53岁(范围，27-68岁）在手术时。5年生存率为75.3％，至少10年生存率为63.2％。那些进展为关节成形术的人平均为4.7年(范围，0.8-9.6年）。对于那些没有接受关节置换术的人，术后5年（63.3至89.6；P<.001）和10年（63.3至80.6；P=.007），美国肩肘外科医生的评分显着提高。在93.8％的失败患者中，CAM失败与严重的术前肱骨头不协调相关，而未进行关节成形术的患者为50.0％（P=.008）。满意度中位数为10分之7.5。
接受CAM手术的年轻GHOA患者在至少10年的随访中，患者报告的预后得到了显著改善。最低10年随访生存率为63.2%。肱骨头扁平和严重的关节不协调是CAM失败的危险因素。在适当选择的患者中，CAM程序是GHOA的有效关节保留治疗，在10年内取得持续的积极成果。
