PDF(Pubmed)
Abstract：
UNASSIGNED: Reverse total shoulder arthroplasty (RTSA) has revolutionized the treatment landscape for a spectrum of shoulder pathologies, extending its indications from rotator cuff arthropathy to encompass irreparable rotator cuff lesions, fractures, inflammatory arthritis, and tumors. However, the exponential increase in RTSA usage has brought a proportional rise in associated complications, with dislocation being one of the most common early post-operative complications.
UNASSIGNED: This case report details a 65-year-old right-hand dominant male patient presenting with chronic pain and weakness in the right shoulder, diagnosed with advanced glenohumeral arthritis and massive irreparable rotator cuff tears. The patient underwent a Bony Increased- Offset RTSA (BIO-RTSA) procedure, coupled with subscapularis repair. Postoperatively, the patient experienced pain and instability, culminating in an atraumatic anterior dislocation at 4 months. Despite conservative management, recurrent dislocations persisted. Revision surgery was performed with an increase in the linear component size for containment. About 1 year postoperative of the revision surgery, recurrent dislocation reoccurred. Re-revision surgery was performed with secondary pectoralis major (PM) transfer for subscapularis deficiency due to re-tear from recurrent dislocation, and with an increased humeral tray size for better containment. About 1-year and 6-month post-operative to the re-revision surgery, the patient achieved restored stability, improved range of motion, and reported satisfaction with the outcome.
UNASSIGNED: This case report underscores the challenges of managing recurrent anterior dislocation after RTSA. The successful use of secondary PM transfer highlights its efficacy as a salvage procedure in restoring stability for persistent anterior dislocation after RTSA. Yet, further clinical studies are warranted to establish the role of such interventions in the management for RTSA-associated complications.
UNASSIGNED: Case report.
UNASSIGNED: This case report details a 65-year-old right-hand dominant male patient presenting with chronic pain and weakness in the right shoulder, diagnosed with advanced glenohumeral arthritis and massive irreparable rotator cuff tears. The patient underwent a Bony Increased- Offset RTSA (BIO-RTSA) procedure, coupled with subscapularis repair. Postoperatively, the patient experienced pain and instability, culminating in an atraumatic anterior dislocation at 4 months. Despite conservative management, recurrent dislocations persisted. Revision surgery was performed with an increase in the linear component size for containment. About 1 year postoperative of the revision surgery, recurrent dislocation reoccurred. Re-revision surgery was performed with secondary pectoralis major (PM) transfer for subscapularis deficiency due to re-tear from recurrent dislocation, and with an increased humeral tray size for better containment. About 1-year and 6-month post-operative to the re-revision surgery, the patient achieved restored stability, improved range of motion, and reported satisfaction with the outcome.
UNASSIGNED: This case report underscores the challenges of managing recurrent anterior dislocation after RTSA. The successful use of secondary PM transfer highlights its efficacy as a salvage procedure in restoring stability for persistent anterior dislocation after RTSA. Yet, further clinical studies are warranted to establish the role of such interventions in the management for RTSA-associated complications.
UNASSIGNED: Case report.
摘要：
■反向全肩关节成形术（RTSA）彻底改变了一系列肩关节病变的治疗前景，将其适应症从肩袖关节病扩展到包括不可修复的肩袖病变，骨折,炎性关节炎,和肿瘤。然而,RTSA使用量的指数增长带来了相关并发症的成比例上升，脱位是最常见的术后早期并发症之一。
本病例报告详述了一名65岁的右手优势男性患者，表现为右肩慢性疼痛和虚弱，诊断为晚期肱骨关节炎和大量不可修复的肩袖撕裂。患者接受了Bony递增偏移RTSA（BIO-RTSA）手术，再加上肩胛骨下修复.术后,患者经历了疼痛和不稳定，在4个月时达到无创伤前脱位。尽管管理保守,复发性脱位持续存在。进行翻修手术时，线性组件尺寸会增加以容纳。翻修手术后约1年，复发性脱位复发。由于复发性脱位引起的再撕裂，对肩胛骨下缺损进行了二次胸大肌（PM）转移手术，并增加了肱骨托盘的大小，以更好地容纳。大约1年和6个月的术后重新修正手术，病人恢复了稳定，改进的运动范围，并报告对结果的满意度。
■该病例报告强调了处理RTSA术后复发性前脱位的挑战。成功使用二次PM转移凸显了其在恢复RTSA后持续性前脱位的稳定性方面作为挽救程序的功效。然而，需要进一步的临床研究来确定此类干预措施在RTSA相关并发症管理中的作用.
■病例报告。
本病例报告详述了一名65岁的右手优势男性患者，表现为右肩慢性疼痛和虚弱，诊断为晚期肱骨关节炎和大量不可修复的肩袖撕裂。患者接受了Bony递增偏移RTSA（BIO-RTSA）手术，再加上肩胛骨下修复.术后,患者经历了疼痛和不稳定，在4个月时达到无创伤前脱位。尽管管理保守,复发性脱位持续存在。进行翻修手术时，线性组件尺寸会增加以容纳。翻修手术后约1年，复发性脱位复发。由于复发性脱位引起的再撕裂，对肩胛骨下缺损进行了二次胸大肌（PM）转移手术，并增加了肱骨托盘的大小，以更好地容纳。大约1年和6个月的术后重新修正手术，病人恢复了稳定，改进的运动范围，并报告对结果的满意度。
■该病例报告强调了处理RTSA术后复发性前脱位的挑战。成功使用二次PM转移凸显了其在恢复RTSA后持续性前脱位的稳定性方面作为挽救程序的功效。然而，需要进一步的临床研究来确定此类干预措施在RTSA相关并发症管理中的作用.
■病例报告。
