Abstract：
The role of the subscapularis following reverse shoulder arthroplasty (RSA) remains controversial as repair could restore adequate internal rotation and shoulder stability, but might compromise external rotation. The purpose of this multi-centre study, on a large cohort of RSAs performed using the deltopectoral approach, was to determine the effect of subscapularis preoperative status and intraoperative repair on range of motion, clinical scores and rates of complications at a minimum follow-up of 2 years.
Repair of a functional subscapularis grants better internal rotation and stability without compromising external rotation.
We retrospectively reviewed records of all RSAs (n=916) performed by 14 surgeons that participated in a large national society symposium, and excluded 234 operated by the anterosuperior approach, 42 operated for rheumatoid arthritis, fractures, instability or post traumatic sequalae, and eight that had adjuvant latissimus dorsi tendon transfer (LDTT). This left 632 RSAs, in which the subscapularis was detached in 594, and repaired after detachment in 495. Patients completed pre- and postoperative Constant Score and postoperative Subjective Shoulder Value (SSV). Active forward elevation, active external rotation (ER), and active internal rotation (IR) were recorded pre- and postoperatively. Complications following RSA that required conservative treatment, reoperation without implant removal, as well as reoperation with implant removal were recorded.
Of the initial cohort of 632 shoulders, 120 (19%) were lost to follow-up, 12 (2%) died due to causes unrelated to RSA, and 26 (4%) were revised with implant removal. Of the remaining 474 shoulders, 259 (55%) had a functional repaired subscapularis (Group FR), 59 (12%) had a non-functional repaired subscapularis (Group nFR), whereas 68 (14%) had a not repaired subscapularis (Group nR). Comparison of patient demographics revealed no significant differences among the three groups. Postoperative Constant Score (p=0.031) and SSV (p=0.016) were significantly different among the three groups, but effect sizes were small and not clinically relevant. Differences in postoperative ER as well as postoperative IR were not significant among the three groups: 91 (35%) gained functional IR in Group FR, 11 (19%) in Group nFR, and 13 (19%) in Group nR. Three shoulders (1.2%) reported subjective instability and 1 (0.4%) dislocated in Group FR, but none in either Groups nFR or nR.
Despite statistically significant differences in Constant Score and SSV among the three groups, the clinical relevance of these differences is negligible, so repair of functional subscapularis has little or no influence on functional outcomes. During RSA by deltopectoral approach, repair of a functional subscapularis could slightly improve internal rotation in some patients but does not compromise external rotation, forward elevation or clinical scores, while repair of a non-functional subscapularis, compared to non-repair, did not improve range of motion or clinical scores.
III; retrospective comparative.
Repair of a functional subscapularis grants better internal rotation and stability without compromising external rotation.
We retrospectively reviewed records of all RSAs (n=916) performed by 14 surgeons that participated in a large national society symposium, and excluded 234 operated by the anterosuperior approach, 42 operated for rheumatoid arthritis, fractures, instability or post traumatic sequalae, and eight that had adjuvant latissimus dorsi tendon transfer (LDTT). This left 632 RSAs, in which the subscapularis was detached in 594, and repaired after detachment in 495. Patients completed pre- and postoperative Constant Score and postoperative Subjective Shoulder Value (SSV). Active forward elevation, active external rotation (ER), and active internal rotation (IR) were recorded pre- and postoperatively. Complications following RSA that required conservative treatment, reoperation without implant removal, as well as reoperation with implant removal were recorded.
Of the initial cohort of 632 shoulders, 120 (19%) were lost to follow-up, 12 (2%) died due to causes unrelated to RSA, and 26 (4%) were revised with implant removal. Of the remaining 474 shoulders, 259 (55%) had a functional repaired subscapularis (Group FR), 59 (12%) had a non-functional repaired subscapularis (Group nFR), whereas 68 (14%) had a not repaired subscapularis (Group nR). Comparison of patient demographics revealed no significant differences among the three groups. Postoperative Constant Score (p=0.031) and SSV (p=0.016) were significantly different among the three groups, but effect sizes were small and not clinically relevant. Differences in postoperative ER as well as postoperative IR were not significant among the three groups: 91 (35%) gained functional IR in Group FR, 11 (19%) in Group nFR, and 13 (19%) in Group nR. Three shoulders (1.2%) reported subjective instability and 1 (0.4%) dislocated in Group FR, but none in either Groups nFR or nR.
Despite statistically significant differences in Constant Score and SSV among the three groups, the clinical relevance of these differences is negligible, so repair of functional subscapularis has little or no influence on functional outcomes. During RSA by deltopectoral approach, repair of a functional subscapularis could slightly improve internal rotation in some patients but does not compromise external rotation, forward elevation or clinical scores, while repair of a non-functional subscapularis, compared to non-repair, did not improve range of motion or clinical scores.
III; retrospective comparative.
摘要：
背景：反向肩关节置换术（RSA）后肩胛骨下的作用仍然存在争议：修复可以恢复足够的内旋和肩关节稳定性，但可能会损害外部旋转。这项多中心研究的目的是，在使用三角学方法进行的大量RSAs中，是为了确定肩胛骨下术前状态和术中修复对活动范围的影响，至少随访2年的临床评分和并发症发生率。
目的：功能性肩胛骨下的修复在不影响外旋的情况下给予更好的内旋和稳定性。
方法：我们回顾性回顾了由14名外科医生进行的所有RSAs（n=916）的记录，排除了234个由前上方法操作的方法，42为类风湿性关节炎手术，骨折,不稳定或创伤后后遗症，和8个有辅助背阔肌肌腱转移（LDTT）。这留下了632个注册会计师，其中肩胛骨在594年脱离，在495年脱离后修复。患者完成术前和术后恒定评分和术后主观肩关节值(SSV)。活动前高程,主动外部旋转(ER)，在术前和术后记录主动内旋（IR）。RSA后的并发症需要保守治疗，在不移除植入物的情况下再次手术，记录了再手术以及移除植入物的情况。
结果：在最初的632个肩群中，120人(19%)失去随访，12人（2%）因与RSA无关的原因死亡，26例(4%)通过移除植入物进行了修订。剩下的474个肩膀,259例（55%）肩胛骨下功能修复（FR组），59例（12%）肩胛骨下无功能修复（nFR组），而68（14％）的肩胛骨下未修复（nR组）。患者人口统计学比较(年龄，体重指数和性别）显示三组之间没有显着差异。术后恒定评分(p=0.031)和SSV(p=0.016)三组间差异有统计学意义。但效应量小,与临床无关.三组之间术后ER和术后IR的差异不显着：FR组91（35％）获得了功能性IR，11（19%）在nFR组中，nR组中有13名（19%）。在FR组中，三肩（1.2%）报告主观不稳定，1肩（0.4%）脱臼，但nFR或nR组中都没有。
结论：尽管三组之间的ConstantScore和SSV有统计学上的显著差异，这些差异的临床相关性可以忽略不计，因此，功能性肩胛骨下修复对功能结局影响很小或没有影响。在RSA期间，通过deltopecorial方法，功能性肩胛骨下修复可以稍微改善一些患者的内旋，但不会损害外旋，正向抬高或临床评分，在修复无功能的肩胛骨下，与非修复相比，没有改善运动范围或临床评分。
方法：III；回顾性比较。
目的：功能性肩胛骨下的修复在不影响外旋的情况下给予更好的内旋和稳定性。
方法：我们回顾性回顾了由14名外科医生进行的所有RSAs（n=916）的记录，排除了234个由前上方法操作的方法，42为类风湿性关节炎手术，骨折,不稳定或创伤后后遗症，和8个有辅助背阔肌肌腱转移（LDTT）。这留下了632个注册会计师，其中肩胛骨在594年脱离，在495年脱离后修复。患者完成术前和术后恒定评分和术后主观肩关节值(SSV)。活动前高程,主动外部旋转(ER)，在术前和术后记录主动内旋（IR）。RSA后的并发症需要保守治疗，在不移除植入物的情况下再次手术，记录了再手术以及移除植入物的情况。
结果：在最初的632个肩群中，120人(19%)失去随访，12人（2%）因与RSA无关的原因死亡，26例(4%)通过移除植入物进行了修订。剩下的474个肩膀,259例（55%）肩胛骨下功能修复（FR组），59例（12%）肩胛骨下无功能修复（nFR组），而68（14％）的肩胛骨下未修复（nR组）。患者人口统计学比较(年龄，体重指数和性别）显示三组之间没有显着差异。术后恒定评分(p=0.031)和SSV(p=0.016)三组间差异有统计学意义。但效应量小,与临床无关.三组之间术后ER和术后IR的差异不显着：FR组91（35％）获得了功能性IR，11（19%）在nFR组中，nR组中有13名（19%）。在FR组中，三肩（1.2%）报告主观不稳定，1肩（0.4%）脱臼，但nFR或nR组中都没有。
结论：尽管三组之间的ConstantScore和SSV有统计学上的显著差异，这些差异的临床相关性可以忽略不计，因此，功能性肩胛骨下修复对功能结局影响很小或没有影响。在RSA期间，通过deltopecorial方法，功能性肩胛骨下修复可以稍微改善一些患者的内旋，但不会损害外旋，正向抬高或临床评分，在修复无功能的肩胛骨下，与非修复相比，没有改善运动范围或临床评分。
方法：III；回顾性比较。
