Abstract：
Latissimus dorsi transfer (LDT) has been purported to restore motion in patients undergoing reverse shoulder arthroplasty (RSA) who have preoperative combined loss of forward elevation (FE) and external rotation (ER). This systematic review summarizes the available evidence for the functional outcomes and complications after RSA with LDT. Furthermore, the effect of implant design and whether a concomitant teres major transfer (TMT) was performed were studied.
A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on LDT with RSA to restore ER. Our primary outcomes were ER, FE, Constant score, and complication incidence. Secondarily, we reported postoperative internal rotation (IR) and compared ER, FE, and Constant score based on lateralized versus medialized global implant design and whether concomitant TMT was performed.
Nineteen studies were evaluated; functional outcomes were assessed in 16 articles reporting on 258 RSAs (123 LDT, 135 LDT-TMT). Surgical indication was most commonly cuff tear arthropathy and massive irreparable cuff tear. Mean ER was -12° preoperatively and 25° postoperatively, FE was 72° preoperatively and 141° postoperatively. Mean postoperative Constant score was 65. Of 138 patients (8 studies) describing IR, only 25% reported a mean postoperative IR ≥L3. Subanalysis comparing lateralized versus medialized implants and whether TMT was concomitantly performed demonstrated no significant difference in postoperative ER, FE, and Constant score, nor preoperative to postoperative improvement in ER and FE. The complication rate was 14.1% (of 291 shoulders from 16 studies), including tear in the tendon transfer (n = 3), revision tendon repair (n = 1), nerve-related complication (n = 9), and dislocation (n = 9).
RSA with LDT is a reliable option to restore motion, with a comparable complication rate with standard RSA. The use of medialized versus lateralized implants and whether the TM was concomitantly transferred may not influence clinical outcomes.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on LDT with RSA to restore ER. Our primary outcomes were ER, FE, Constant score, and complication incidence. Secondarily, we reported postoperative internal rotation (IR) and compared ER, FE, and Constant score based on lateralized versus medialized global implant design and whether concomitant TMT was performed.
Nineteen studies were evaluated; functional outcomes were assessed in 16 articles reporting on 258 RSAs (123 LDT, 135 LDT-TMT). Surgical indication was most commonly cuff tear arthropathy and massive irreparable cuff tear. Mean ER was -12° preoperatively and 25° postoperatively, FE was 72° preoperatively and 141° postoperatively. Mean postoperative Constant score was 65. Of 138 patients (8 studies) describing IR, only 25% reported a mean postoperative IR ≥L3. Subanalysis comparing lateralized versus medialized implants and whether TMT was concomitantly performed demonstrated no significant difference in postoperative ER, FE, and Constant score, nor preoperative to postoperative improvement in ER and FE. The complication rate was 14.1% (of 291 shoulders from 16 studies), including tear in the tendon transfer (n = 3), revision tendon repair (n = 1), nerve-related complication (n = 9), and dislocation (n = 9).
RSA with LDT is a reliable option to restore motion, with a comparable complication rate with standard RSA. The use of medialized versus lateralized implants and whether the TM was concomitantly transferred may not influence clinical outcomes.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
摘要：
背景：背阔肌转移（LDT）被认为可以恢复接受反向肩关节成形术（RSA）的患者的运动，这些患者术前合并前抬高（FE）和外旋（ER）丧失。本系统综述总结了RSA合并LDT后功能结局和并发症的现有证据。此外，研究了植入物设计的效果以及是否进行了伴随的大圆移植(TMT).
方法：根据系统评价和荟萃分析指南的首选报告项目进行系统评价。我们查询了PubMed/MEDLINE,Embase,WebofScience,和Cochrane数据库，以识别报告LDT的文章，并使用RSA恢复ER。我们的主要结果是ER，FE,恒定的分数，和并发症发生率。其次，我们报告了术后内旋（IR），并比较了ER，FE,和Constant评分基于横向和中介的整体植入物设计以及是否同时进行TMT。
结果：评估了19项研究；在16篇报告258个RSAs的文章中评估了功能结局（123LDT，135LDT-TMT）。手术指征最常见的是袖带撕裂关节病和无法修复的大量袖带撕裂。平均ER术前为-12°，术后为25°，FE术前为72°，术后为141°。术后Constant评分均值为65。在描述IR的138名患者（8项研究）中，只有25%的人报告平均术后IR≥L3.比较侧化与中介化植入物以及是否同时进行TMT的亚分析显示术后ER无显著差异，FE,和恒定的分数，术前和术后ER和FE的改善也没有。并发症发生率为14.1%（来自16项研究的291个肩部），包括肌腱转移中的撕裂(n=3)，翻修肌腱修复（n=1），神经相关并发症（n=9），和位错(n=9)。
结论：使用LDT的RSA是恢复运动的可靠选择，与标准RSA的并发症发生率相当。使用中介化和侧向化植入物以及TM是否伴随转移可能不会影响临床结果。
方法：四级。有关证据级别的完整描述，请参阅作者说明。
方法：根据系统评价和荟萃分析指南的首选报告项目进行系统评价。我们查询了PubMed/MEDLINE,Embase,WebofScience,和Cochrane数据库，以识别报告LDT的文章，并使用RSA恢复ER。我们的主要结果是ER，FE,恒定的分数，和并发症发生率。其次，我们报告了术后内旋（IR），并比较了ER，FE,和Constant评分基于横向和中介的整体植入物设计以及是否同时进行TMT。
结果：评估了19项研究；在16篇报告258个RSAs的文章中评估了功能结局（123LDT，135LDT-TMT）。手术指征最常见的是袖带撕裂关节病和无法修复的大量袖带撕裂。平均ER术前为-12°，术后为25°，FE术前为72°，术后为141°。术后Constant评分均值为65。在描述IR的138名患者（8项研究）中，只有25%的人报告平均术后IR≥L3.比较侧化与中介化植入物以及是否同时进行TMT的亚分析显示术后ER无显著差异，FE,和恒定的分数，术前和术后ER和FE的改善也没有。并发症发生率为14.1%（来自16项研究的291个肩部），包括肌腱转移中的撕裂(n=3)，翻修肌腱修复（n=1），神经相关并发症（n=9），和位错(n=9)。
结论：使用LDT的RSA是恢复运动的可靠选择，与标准RSA的并发症发生率相当。使用中介化和侧向化植入物以及TM是否伴随转移可能不会影响临床结果。
方法：四级。有关证据级别的完整描述，请参阅作者说明。
