背景:肩袖完整的肩关节关节骨性关节炎伴严重后盂骨丢失可以通过反向肩关节成形术进行处理,但需要进行侧位和版本校正以避免潜在的并发症,比如不稳定,开槽和植入失败。肱骨头自体移植的角度骨移植可以提供持久的关节盂骨原料,但结果喜忧参半。这项研究的目的是评估接受角度肱骨头自体移植治疗严重逆行的患者的患者报告和客观结果以及并发症和失败率。
方法:在我们机构的2018年11月至2022年2月期间,所有患者均接受了带角度肱骨头自体移植和StrykerTornier长中央后基板的原发性RSA治疗严重的关节盂骨丢失,其中肩袖完整。包括主要诊断为骨关节炎和术前关节盂逆行≥30°的个体。正在进行修订程序的患者,计划中的两阶段关节成形术被排除.术前和术后活动范围的差异,并评估了患者报告的结局.术中并发症,术后并发症,并对再手术率进行了分析。
结果:23例患者(61%为男性)共24肩,包括平均年龄65.6岁.术前平均逆行37.4°(范围:30°-51°)。平均随访时间为2.9年(范围:2-4.3年)。在屈曲方面发现了显著的改善,绑架,和外部旋转。患者报告的主观结果非常好,平均ASES评分为93.6,平均SSV为93.8%。16个(67%)的肩膀接受了术后CT扫描,发现全部合并。并发症包括1例肩关节血肿需切开引流而未翻修。11个月时下关节盂螺钉的创伤后骨折,需要用植骨翻修RSA。没有因部件松动而发生无创伤的灾难性故障。
结论:这项研究表明,使用斜角肱骨头植骨是一种很好的解决方案,可以用于后部关节盂骨丢失的版本矫正。ROM中报告了重大改进,疼痛,和主观功能得分,在早期随访中具有优异的移植物结合率和低并发症。进一步的工作应侧重于收集更高水平的证据,详细的影像学分析和探索肱骨头植骨的其他适应症。
BACKGROUND: Severe posterior glenoid bone loss with glenohumeral osteoarthritis with an intact rotator cuff can be managed with reverse shoulder arthroplasty but requires lateralization and version correction to avoid potential complications, such as instability, notching and implant failure. Angled bone grafting with humeral head autograft can provide durable glenoid bone stock, but results have been mixed. The purpose of this study was to evaluate patient-reported and objective outcomes as well as complication and failure rates for patients who underwent angled humeral head autografting for severe retroversion.
METHODS: All patients who underwent a primary RSA with angled humeral head autograft and Stryker Tornier long central post baseplate for severe glenoid bone loss in the setting of glenohumeral osteoarthritis with an intact rotator cuff at our institution between November 2018 and February of 2022 were identified. Individuals with a primary diagnosis of osteoarthritis and preoperative glenoid retroversion of ≥30° were included. Patients undergoing revision procedures, planned two-stage arthroplasty were excluded. Differences in pre- and postoperative range of motion, as well as patient-reported outcomes were assessed. Intraoperative complications, postoperative complications, and re-operation rates were analyzed.
RESULTS: A total of 24 shoulders in 23 patients (61% male), with a mean age of 65.6 years were included. Average preoperative retroversion was 37.4° (range: 30° - 51°). Mean follow-up was 2.9 years (range: 2 - 4.3 years). Significant improvements were found in flexion, abduction, and external rotation. Patient-reported subjective outcomes were excellent, with average ASES score of 93.6 and average SSV 93.8%. Sixteen (67%) shoulders received postoperative CT scans and all were found to have incorporated. Complications included one shoulder hematoma requiring incision and drainage without revision, and a post-traumatic fracture of the inferior glenoid screw at 11 months, requiring revision RSA with bone grafting. No atraumatic catastrophic failures occurred due to component loosening.
CONCLUSIONS: This study suggests that using angled humeral head bone grafting is a good solution for version correction in extreme posterior glenoid bone loss. Significant improvements are reported in ROM, pain, and subjective functional scores, with excellent graft incorporation rates and a low complication profile at early follow-up. Further work should focus on gathering higher levels of evidence, detailed radiographic analyses and exploring humeral head bone grafting for other indications.