背景:肱骨干可能是肩关节成形术中出现问题的原因,例如骨质流失,术中和术后假体周围骨折或术后感染累及髓管。因此,无茎反向肩关节置换术(slRSA)已经越来越受欢迎,特别是在保存骨骼方面。然而,关于slRSA中期结局的可用数据有限.这项研究的目的是评估临床,放射学,和患者报告的slRSA的最低随访期为两年。
方法:收集2016年1月至2020年10月期间植入的所有无茎反向肩假体的数据。6周时对患者进行随访,6个月,12个月,术后24个月。临床和放射学数据以及患者报告的结果测量(PROM)通过经过验证的问卷进行评估(UCLA,ASES,快速破折号,VAS疼痛,主观肩值(SSV),Constant-MurleyScore(CS)).所有患者至少随访2年。
结果:在观察期间,25例患者中的26肩符合纳入标准。平均随访时间为46.8个月(25-66个月)。平均年龄为70.1岁(范围为59.9-86.4岁)。在最近的随访中,ASES评分显着改善(55.9±19.9vs.85.6±10.7,p<0.001),SSV(44.3±18.7vs.85.3±10.4,p<0.001),快速短跑分数(40.6±22.0vs.17.8±13.9,p<0.001),VAS疼痛评分(4.6±3.2vs.0.9±1.2,p<0.001)和屈曲时的ROM(66±53vs.154±22,p<0.001)以及绝对值(44.1±18.7vs.83.1±10.1,p<0.001)和相对CS(62.1±27.8vs.111.9±13.3,p<0.001)。在16%的病例中观察到肩胛骨切口,在28%的没有植入物松动症状的病例中检测到射线可透的线。由于与无茎肱骨组件有关的任何原因,都不需要进行翻修。
结论:ASES评分提高了30分,因此超过了21分的MCID,并且由于无茎成分而没有修订,这些结果表明,SLRSA是一个可行的选择,提供良好到良好的中期结果,可与柄式反向肩部假体相媲美,具有骨原料保存的附加优势。
BACKGROUND: The humeral stem can be a cause of problems in shoulder arthroplasty, for example, loss of bone stock, intraoperative and postoperative periprosthetic fractures, or postoperative infections involving the medullary canal. Therefore, stemless reverse shoulder arthroplasty (slRSA) has gained popularity, particularly in terms of preserving bone stock. However, there are limited data available on the midterm outcomes of slRSA. The objective of this study was to evaluate the clinical, radiologic, and patient-reported outcomes of slRSA at a minimum follow-up period of 2 years.
METHODS: Data on all stemless reverse shoulder prostheses implanted between January 2016 and October 2020 were collected. Patients were followed up at 6 weeks and 6, 12, and 24 months postoperatively. Clinical and radiologic data as well as patient-reported outcome measures were assessed with validated questionnaires (University of California at Los Angeles Shoulder Score [UCLA], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Quick Disabilities of the Arm, Shoulder, and Hand questionnaire [Quick-DASH], visual analog scale [VAS] for pain, Subjective Shoulder Value [SSV], and Constant-Murley score [CS]). All patients had a minimum follow-up of 2 years.
RESULTS: During the observation period, 26 shoulders in 25 patients fulfilled the inclusion criteria. The mean follow-up was 46.8 months (range 25-66). The mean age was 70.1 years (range 59.9-86.4). At the most recent follow-up, a significant improvement was noted in the ASES score (55.9 ± 19.9 vs. 85.6 ± 10.7, P < .001), SSV (44.3 ± 18.7 vs. 85.3 ± 10.4, P < .001), Quick-DASH score (40.6 ± 22.0 vs. 17.8 ± 13.9, P < .001), VAS pain score (4.6 ± 3.2 vs. 0.9 ± 1.2, P < .001), and range of motion in flexion (66 ± 53 vs. 154 ± 22, P < .001) as well as in the absolute (44.1 ± 18.7 vs. 83.1 ± 10.1, P < .001) and relative CS (62.1 ± 27.8 vs. 111.9 ± 13.3, P < .001). Scapular notching was observed in 16% of cases, and radiolucent lines were detected in 28% of cases without symptoms of implant loosening. No revision was necessitated by any causes related to the stemless humeral component. Hence, implant survivorship was 100%.
CONCLUSIONS: With an ASES score showing a 30-point improvement and thus exceeding the minimal clinically important difference of 21 points and no revisions due to the stemless component, these results indicate that slRSA is a viable option, providing good to excellent midterm outcomes that are comparable to those of stemmed reverse shoulder prostheses, with the added advantage of bone stock preservation.