背景:这项研究的目的是评估反向全肩关节置换术(RTSA)后的侧向和扩张的多种影像学检查与临床结果评分之间的关系。
方法:我们回顾性评估了高级作者在2007年1月1日至2017年11月1日期间进行的所有RTSA。然后我们评估疼痛的视觉模拟量表(VAS疼痛),简单肩部测试(SST),以及美国肩肘外科医师(ASES)评分和并发症以及至少2年随访的再手术率。我们测量了术前和术后(2周)侧化肩角(LSA)的X光片,远端肩角(DSA),肱骨外侧偏移(LHO),和从关节盂到大结节(GLAGT)的外侧的距离。进行了多变量分析,评估了术后影像学测量对最终患者报告结果的影响(ASES评分,SST,VAS疼痛)。
结果:该队列包括216名独特患者的肩膀,这些患者在至少2年的随访中获得了患者报告的结果评分(平均,4.0±1.9年),总随访率为70%。在多变量模型中,更多的侧化(LSA)与更差的最终ASES评分-0.52(95%CI:-0.88至-0.17;p=0.004)相关,更多的远端(DSA)与更好的最终ASES评分0.40相关(95%CI:0.11,0.69;p=0.007).更多的侧化(LSA)与更差的最终SST评分-0.06(95%CI:-0.11,-0.003;p=0.039)相关。最后,较大的扩张(DSA)与较低的最终VAS疼痛评分相关,比率=0.98(95%CI:0.96,1.00;p=0.021)。
结论:Grammont型RTSA后更大的扩张和更少的侧向扩张与更好的功能和更少的疼痛相关。如果使用Grammont型植入物,与Grammont的植入原则保持一致将提供更好的最终临床结果。
BACKGROUND: The purpose of this study was to evaluate the relationship between multiple radiographic measures of lateralization and
distalization and clinical outcome scores after a reverse total shoulder arthroplasty (RTSA).
METHODS: We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We then evaluated the visual analog scale for pain (VAS pain), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We measured preoperative and postoperative (2-week) radiographs for the lateralization shoulder angle (LSA), the
distalization shoulder angle (DSA), lateral humeral offset, and the distance from the glenoid to the lateral aspect of the greater tuberosity. A multivariable analysis was performed to evaluate the effect of the postoperative radiographic measurements on final patient-reported outcomes (ASES scores, SST, and VAS pain).
RESULTS: The cohort included 216 shoulders from unique patients who had patient-reported outcome scores available at a minimum of 2-year follow-up (average, 4.0 ± 1.9 years) for a total follow-up rate of 70%. In the multivariable models, more lateralization (LSA) was associated with worse final ASES scores -0.52 (95% confidence interval [CI]: -0.88, -0.17; P = .004), and more
distalization (DSA) was associated with better final ASES scores 0.40 (95% CI: 0.11, 0.69; P = .007). More lateralization (LSA) was associated with worse final SST scores -0.06 (95% CI: -0.11, -0.003; P = .039). Finally, greater
distalization (DSA) was associated with lower final VAS pain scores, ratio = 0.98 (95% CI: 0.96, 1.00; P = .021).
CONCLUSIONS: Greater
distalization and less lateralization are associated with better function and less pain after a Grammont-style RTSA. When using a Grammont-style implant, remaining consistent with Grammont\'s principles of implant placement will afford better final clinical outcomes.