Abstract：
BACKGROUND: Controversy exists regarding the ideal humeral component version to optimize humeral rotation and patient outcomes in reverse total shoulder arthroplasty (rTSA).
METHODS: Patients undergoing primary rTSA for rotator cuff tear arthropathy, a massive rotator cuff tear, or primary osteoarthritis with a rotator cuff tear were randomized to placement of the humeral component in neutral version or 30° of retroversion. Shoulder active range of motion and strength and visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES), and Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) scores were collected up to 2 years postoperatively. The goal of the study was to determine whether humeral external rotation and internal rotation are affected by humeral component version following rTSA at 2 years postoperatively.
RESULTS: Sixty-six patients were included in the analysis. The median follow-up was 26 months for the neutral and 27 months for the 30° retroversion group. No differences between the groups were observed with respect to the primary diagnosis, sex, age, body mass index, or American Society of Anesthesiologists (ASA) class. The 2 groups did not differ significantly in terms of improvement at 2 years in active shoulder abduction (p = 0.969), forward elevation (p = 1.000), internal rotation measured as the highest spinal level reached (p = 1.000), internal rotation with the arm abducted 90° (p = 0.451), external rotation (p = 0.362), or muscle strength in forward elevation (p = 1.000), abduction (p = 1.000), external rotation (p = 0.617), or internal rotation (p = 1.000). The 2 groups did not differ significantly in terms of improvement in postoperative ASES (p = 1.000), PROMIS-10 physical (p = 1.000), or VAS pain scores (p = 0.718) at the time of final follow-up. In the neutral version group, 1 patient underwent revision for instability and 1 for stiffness. One acromial stress fracture occurred in the 30° humeral retroversion group. Scapular notching was observed in 7 (21.2%) of the patients in neutral version group and 5 (15.2%) of the patients in the 30° retroversion group (p = 0.750).
CONCLUSIONS: Securing the humeral component at neutral version or 30° of retroversion in rTSA resulted in similar active shoulder external rotation, internal rotation, forward elevation, abduction, and strength measurements, complication rates, and VAS pain, PROMIS-10 physical, and ASES scores at 2 years postoperatively.
METHODS: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
METHODS: Patients undergoing primary rTSA for rotator cuff tear arthropathy, a massive rotator cuff tear, or primary osteoarthritis with a rotator cuff tear were randomized to placement of the humeral component in neutral version or 30° of retroversion. Shoulder active range of motion and strength and visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES), and Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) scores were collected up to 2 years postoperatively. The goal of the study was to determine whether humeral external rotation and internal rotation are affected by humeral component version following rTSA at 2 years postoperatively.
RESULTS: Sixty-six patients were included in the analysis. The median follow-up was 26 months for the neutral and 27 months for the 30° retroversion group. No differences between the groups were observed with respect to the primary diagnosis, sex, age, body mass index, or American Society of Anesthesiologists (ASA) class. The 2 groups did not differ significantly in terms of improvement at 2 years in active shoulder abduction (p = 0.969), forward elevation (p = 1.000), internal rotation measured as the highest spinal level reached (p = 1.000), internal rotation with the arm abducted 90° (p = 0.451), external rotation (p = 0.362), or muscle strength in forward elevation (p = 1.000), abduction (p = 1.000), external rotation (p = 0.617), or internal rotation (p = 1.000). The 2 groups did not differ significantly in terms of improvement in postoperative ASES (p = 1.000), PROMIS-10 physical (p = 1.000), or VAS pain scores (p = 0.718) at the time of final follow-up. In the neutral version group, 1 patient underwent revision for instability and 1 for stiffness. One acromial stress fracture occurred in the 30° humeral retroversion group. Scapular notching was observed in 7 (21.2%) of the patients in neutral version group and 5 (15.2%) of the patients in the 30° retroversion group (p = 0.750).
CONCLUSIONS: Securing the humeral component at neutral version or 30° of retroversion in rTSA resulted in similar active shoulder external rotation, internal rotation, forward elevation, abduction, and strength measurements, complication rates, and VAS pain, PROMIS-10 physical, and ASES scores at 2 years postoperatively.
METHODS: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
摘要：
背景：关于在反向全肩关节置换术（rTSA）中优化肱骨旋转和患者预后的理想肱骨组件版本存在争议。
方法：接受原发性rTSA治疗肩袖撕裂性关节病的患者，巨大的肩袖撕裂,或伴有肩袖撕裂的原发性骨关节炎被随机分配到以中性版本或30°后倾放置肱骨组件。肩关节活动范围和力量及视觉模拟量表(VAS)疼痛,美国肩肘外科医师（ASES），收集患者报告的结果测量信息系统Global10（PROMIS-10）评分，直至术后2年。该研究的目的是确定rTSA术后2年肱骨外旋和内旋是否受肱骨组件版本的影响。
结果：66例患者纳入分析。中性组的中位随访时间为26个月，30°逆行组的中位随访时间为27个月。在主要诊断方面，两组之间没有观察到差异，性别,年龄,身体质量指数,或美国麻醉医师协会（ASA）类。两组在2年的积极肩外展改善方面没有显着差异（p=0.969），正向高程（p=1.000），内旋转测量为达到最高脊柱水平（p=1.000），手臂外展90°的内部旋转（p=0.451），外部旋转（p=0.362），或向前抬高的肌肉力量（p=1.000），绑架（p=1.000），外部旋转（p=0.617），或内部旋转（p=1.000）。两组在术后ASES改善方面无显著差异(p=1.000),PROMIS-10物理（p=1.000），或最终随访时的VAS疼痛评分（p=0.718）。在中性版本组中，1例患者因不稳定而进行翻修，1例患者因僵硬而进行翻修。30°肱骨逆行组1例发生肩峰应力性骨折。在中性版组的患者中有7例（21.2％），在30°后翻组的患者中有5例（15.2％）（p=0.750）。
结论：在rTSA中将肱骨组件固定在中性版本或30°的后倾导致类似的主动肩外旋转，内部旋转,向前高程,绑架,和强度测量，并发症发生率,和VAS疼痛，PROMIS-10物理，术后2年的ASES评分。
方法：治疗级别I.有关证据级别的完整描述，请参阅作者说明。
方法：接受原发性rTSA治疗肩袖撕裂性关节病的患者，巨大的肩袖撕裂,或伴有肩袖撕裂的原发性骨关节炎被随机分配到以中性版本或30°后倾放置肱骨组件。肩关节活动范围和力量及视觉模拟量表(VAS)疼痛,美国肩肘外科医师（ASES），收集患者报告的结果测量信息系统Global10（PROMIS-10）评分，直至术后2年。该研究的目的是确定rTSA术后2年肱骨外旋和内旋是否受肱骨组件版本的影响。
结果：66例患者纳入分析。中性组的中位随访时间为26个月，30°逆行组的中位随访时间为27个月。在主要诊断方面，两组之间没有观察到差异，性别,年龄,身体质量指数,或美国麻醉医师协会（ASA）类。两组在2年的积极肩外展改善方面没有显着差异（p=0.969），正向高程（p=1.000），内旋转测量为达到最高脊柱水平（p=1.000），手臂外展90°的内部旋转（p=0.451），外部旋转（p=0.362），或向前抬高的肌肉力量（p=1.000），绑架（p=1.000），外部旋转（p=0.617），或内部旋转（p=1.000）。两组在术后ASES改善方面无显著差异(p=1.000),PROMIS-10物理（p=1.000），或最终随访时的VAS疼痛评分（p=0.718）。在中性版本组中，1例患者因不稳定而进行翻修，1例患者因僵硬而进行翻修。30°肱骨逆行组1例发生肩峰应力性骨折。在中性版组的患者中有7例（21.2％），在30°后翻组的患者中有5例（15.2％）（p=0.750）。
结论：在rTSA中将肱骨组件固定在中性版本或30°的后倾导致类似的主动肩外旋转，内部旋转,向前高程,绑架,和强度测量，并发症发生率,和VAS疼痛，PROMIS-10物理，术后2年的ASES评分。
方法：治疗级别I.有关证据级别的完整描述，请参阅作者说明。
