PDF(Pubmed)
Abstract：
UNASSIGNED: To determine, from a sizable cohort of reverse shoulder arthroplasty (RSA), whether the deltopectoral (DP) or anterosuperior (AS) approach grant better outcomes at a minimum follow-up of 24 months.
UNASSIGNED: The authors reviewed 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff lesions and secondary OA due to rotator cuff tears. The DP approach was used in 540 and the AS approach in 203. Pre- and post-operative constant scores (CSs) and shoulder range of motion were recorded.
UNASSIGNED: Of the initial cohort of 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised; 540 shoulders were operated using DP approach (73%), of which 22 were revised (4.1%), while 203 were operated using the AS approach (27%), of which 11 were revised (5.4%). Propensity score matching resulted in two groups: 172 shoulders operated by DP approach, and 88 shoulders operated by AS approach. Comparing outcomes of the matched groups at 2 or more years also revealed that, compared to the AS approach, the DP approach resulted in significantly better post-operative CSs (67.3 ± 14.0° vs 60.8 ± 18.3, P = 0.017), active forward elevation (137° ± 27.4° vs 129° ± 29.8; P = 0.031).
UNASSIGNED: At 2 or more years following RSA, the DP approach granted significantly better CS (by 6.5 points) and active forward elevation (by 8°) compared to the AS approach. The differences observed are clinically relevant and must be considered to manage patient expectations following RSA and for selecting surgical approach depending on their functional needs.
UNASSIGNED: III, comparative study.
UNASSIGNED: The authors reviewed 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff lesions and secondary OA due to rotator cuff tears. The DP approach was used in 540 and the AS approach in 203. Pre- and post-operative constant scores (CSs) and shoulder range of motion were recorded.
UNASSIGNED: Of the initial cohort of 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised; 540 shoulders were operated using DP approach (73%), of which 22 were revised (4.1%), while 203 were operated using the AS approach (27%), of which 11 were revised (5.4%). Propensity score matching resulted in two groups: 172 shoulders operated by DP approach, and 88 shoulders operated by AS approach. Comparing outcomes of the matched groups at 2 or more years also revealed that, compared to the AS approach, the DP approach resulted in significantly better post-operative CSs (67.3 ± 14.0° vs 60.8 ± 18.3, P = 0.017), active forward elevation (137° ± 27.4° vs 129° ± 29.8; P = 0.031).
UNASSIGNED: At 2 or more years following RSA, the DP approach granted significantly better CS (by 6.5 points) and active forward elevation (by 8°) compared to the AS approach. The differences observed are clinically relevant and must be considered to manage patient expectations following RSA and for selecting surgical approach depending on their functional needs.
UNASSIGNED: III, comparative study.
摘要：
■要确定，来自相当大的反向肩关节置换术(RSA)队列，在至少24个月的随访时间内,无论术前(DP)还是术前(AS)方法均可获得更好的结局.
■作者回顾了743例原发性骨关节炎（OA）伴或不伴肩袖损伤和继发性OA患者由于肩袖撕裂的情况。540采用DP方法，203采用AS方法。记录术前和术后恒定评分（CSs）和肩部活动范围。
■在最初的743肩队列中，193例（25.7%）失访，16人(2.1%)死亡，修订了33个(4.4%)；540个路肩采用DP法(73%)，其中22项修订(4.1%),而203人采用AS方法(27%)，其中11项修订(5.4%)。倾向评分匹配导致两组：采用DP方法操作的172个肩膀，和通过AS方法操作的88个肩膀。比较2年或更长时间的匹配组的结果也表明，与AS方法相比，DP入路术后CSs显著改善(67.3±14.0°vs60.8±18.3,P=0.017),主动前倾（137°±27.4°vs129°±29.8；P=0.031）。
■在RSA之后2年或更长时间，与AS方法相比，DP方法赋予了显着更好的CS（6.5点）和主动向前仰角（8°）。观察到的差异是临床相关的，必须考虑在RSA后管理患者的期望，并根据其功能需求选择手术方法。
■III,比较研究。
■作者回顾了743例原发性骨关节炎（OA）伴或不伴肩袖损伤和继发性OA患者由于肩袖撕裂的情况。540采用DP方法，203采用AS方法。记录术前和术后恒定评分（CSs）和肩部活动范围。
■在最初的743肩队列中，193例（25.7%）失访，16人(2.1%)死亡，修订了33个(4.4%)；540个路肩采用DP法(73%)，其中22项修订(4.1%),而203人采用AS方法(27%)，其中11项修订(5.4%)。倾向评分匹配导致两组：采用DP方法操作的172个肩膀，和通过AS方法操作的88个肩膀。比较2年或更长时间的匹配组的结果也表明，与AS方法相比，DP入路术后CSs显著改善(67.3±14.0°vs60.8±18.3,P=0.017),主动前倾（137°±27.4°vs129°±29.8；P=0.031）。
■在RSA之后2年或更长时间，与AS方法相比，DP方法赋予了显着更好的CS（6.5点）和主动向前仰角（8°）。观察到的差异是临床相关的，必须考虑在RSA后管理患者的期望，并根据其功能需求选择手术方法。
■III,比较研究。
