PDF(Pubmed)
Abstract：
UNASSIGNED: Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Specifically, there is theoretical concern about violation of supportive bone with lesser tuberosity osteotomy when using a stemless device. Therefore, the goal of this study was to identify if surgeons change their subscapularis takedown preference when performing stemless vs. stemmed TSA.
UNASSIGNED: Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA.
UNASSIGNED: One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer\'s V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon.
UNASSIGNED: In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon\'s historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.
UNASSIGNED: Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA.
UNASSIGNED: One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer\'s V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon.
UNASSIGNED: In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon\'s historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.
摘要：
■无茎全肩关节成形术（TSA）随着柄型肱骨植入物的发展而继续普及。提出的优点包括骨保存和易于潜在的翻修。然而,缺少茎可能需要改变肩胛骨下取法。具体来说,当使用无茎装置时，理论上存在对小结节截骨术侵犯支持骨的担忧。因此,这项研究的目的是确定外科医生在进行无茎与干TSA。
■收集了在学术机构接受有茎和无茎TSA的连续系列患者的数据。记录了肩胛骨下管理技术。肩胛骨下取下技术分为两组：软组织入路（肩胛骨下腱切开术或剥离术）和骨入路（小结节截骨）。每位外科医生的历史偏好是通过评估使用有茎的TSA所采用的技术来确定的。进行了CramersV分析，以确定这种历史偏好与用于无茎TSA的肩cap下管理技术之间的关联强度。
■本分析纳入了一百五十四名患者。进行了72例和82例无茎和无茎关节成形术，分别。154名患者中,50.6%是女性。患者平均年龄为64.2岁。这项研究包括四名外科医生。总之,有79和75个骨和肩胛骨下软组织技术，分别。历史上对3名外科医生的偏爱是肩胛骨下骨性入路，其中一位外科医生的历史偏好是软组织入路。CramerV分析用于测量患者因素之间的相对关联强度，历史肩胛骨下管理偏好，无茎TSA的肩胛骨下入路。我们的分析得出的值为0.65(P<0.01)，表明每位外科医生在有茎植入物和无茎植入物之间使用的肩胛骨下管理方法之间存在冗余关联。
■在确定肩胛骨下肌腱管理策略时，在无茎TSA之前进行有茎TSA的外科医生中，用于无茎性TSA的肩胛骨下剥离方法与外科医生对有茎性TSA的历史偏好密切相关。未来的研究将需要确定这一发现的临床后果。
■收集了在学术机构接受有茎和无茎TSA的连续系列患者的数据。记录了肩胛骨下管理技术。肩胛骨下取下技术分为两组：软组织入路（肩胛骨下腱切开术或剥离术）和骨入路（小结节截骨）。每位外科医生的历史偏好是通过评估使用有茎的TSA所采用的技术来确定的。进行了CramersV分析，以确定这种历史偏好与用于无茎TSA的肩cap下管理技术之间的关联强度。
■本分析纳入了一百五十四名患者。进行了72例和82例无茎和无茎关节成形术，分别。154名患者中,50.6%是女性。患者平均年龄为64.2岁。这项研究包括四名外科医生。总之,有79和75个骨和肩胛骨下软组织技术，分别。历史上对3名外科医生的偏爱是肩胛骨下骨性入路，其中一位外科医生的历史偏好是软组织入路。CramerV分析用于测量患者因素之间的相对关联强度，历史肩胛骨下管理偏好，无茎TSA的肩胛骨下入路。我们的分析得出的值为0.65(P<0.01)，表明每位外科医生在有茎植入物和无茎植入物之间使用的肩胛骨下管理方法之间存在冗余关联。
■在确定肩胛骨下肌腱管理策略时，在无茎TSA之前进行有茎TSA的外科医生中，用于无茎性TSA的肩胛骨下剥离方法与外科医生对有茎性TSA的历史偏好密切相关。未来的研究将需要确定这一发现的临床后果。
