在过去的几十年中,无柄肩关节成形术在骨关节炎中的应用已大大增加。这项研究的目的是评估LimaSMR无茎解剖和反向全肩关节置换术的临床和放射学结果。
■对73例患者(61例解剖全肩关节置换术[aTSAs]和12例反向肩关节置换术[RSAs])的73个植入物进行了分析,最少随访2年。aTSA组的平均年龄为65.8±8.7,RSA组为78.3±4.8。原发性骨关节炎是大多数病例的适应症(aTSA93.7%,RSA67%)。术前评估患者,在术后4、12和24个月使用Constant评分,ASES,牛津肩分数,EuroQol5维度5级问卷,运动范围得分,和射线照相。使用配对t检验评估统计学意义(P<5)。
■在2年的随访中,总体平均Constant评分从40.0±16.7显著提高至80.9±21.4(P<.001)。ASES(从31.7±15.6提高到82.5±19.4)和牛津肩评分(从19.1±7.4提高到41.9±7.9)也是显著的(P<.001)。在aTSA组中,所有运动范围评分均显著改善(P<.001).在RSA组中,所有运动范围评分均得到改善,但仅外展活动前屈和外旋显著改善(P<0.05)。大多数患者在24个月时满意或完全满意(aTSA93.9%,RSA100%)。RSA配置的两个肱骨植入物在术后第一天显示松动,与施加在肩部的过度力有关。两者都需要对有茎的植入物进行修正。在aTSA组中,没有放射性的迹象,骨质溶解,逐渐松动,或在最后的随访中观察到成分的迁移。在RSA组中,一个病例在12个月时有射线可透的线,肱骨核心下沉,24个月时没有进展,无症状。所有其他RSA病例都没有射线可透的线,迁移,肩胛骨缺口,或骨质溶解。由于无创伤袖带衰竭(N=2)和创伤性袖带衰竭(N=1),将三个解剖植入物通过保留关节盂基板和肱骨核心而转换为反向关节成形术。经过这些程序,患者对结果感到满意。没有其他并发症。
■本研究中提供的2年结果表明,使用SMR无茎系统具有良好的功能和放射学结果。
UNASSIGNED: The use of stemless shoulder arthroplasty for osteoarthritis has grown substantially over the past decades. The goal of this study is to evaluate the clinical and radiological outcomes of the Lima SMR stemless anatomic and reverse total shoulder arthroplasty.
UNASSIGNED: Seventy-three implants in 73 patients (61 anatomic total shoulder arthroplasties [aTSAs] and 12 reverse shoulder arthroplasties [RSAs]) were analyzed with a minimum follow-up of 2 years. The average age in the aTSA group was 65.8 ± 8.7 and 78.3 ± 4.8 in the RSA group. Primary osteoarthritis was the indication in most cases (aTSA 93.7%, RSA 67%). Patients were evaluated preoperatively, at 4, 12, and 24 months postoperatively using the Constant score, the ASES, Oxford Shoulder Score, EuroQol 5 Dimensions 5 Levels questionnaire, range of motion scores, and radiographically. Statistical significance was evaluated using the paired t-test (P < .5).
UNASSIGNED: At 2-year follow-up, the overall average Constant score significantly improved from 40.0 ± 16.7 to 80.9 ± 21.4 (P < .001). Improvement of the ASES (from 31.7 ± 15.6 to 82.5 ± 19.4) and Oxford Shoulder Score (from 19.1 ± 7.4 to 41.9 ± 7.9) was also significant (P < .001). In the aTSA group, all range of motion scores improved significantly (P < .001). In the RSA group, all range of motion scores improved but only active forward flexion and external rotation in abduction improved significantly (P < .05). Most patients were satisfied or completely satisfied at 24 months (aTSA 93.9%, RSA 100%). Two humeral implants in the RSA configuration showed loosening on the first postoperative day related to excessive forces exerted on the shoulder, both requiring revision to a stemmed implant. In the aTSA group, no signs of radiolucencies, osteolysis, gradual loosening, or migration of the components were seen at the final follow-up. In the RSA group, one case had radiolucent lines with subsidence of the humeral core at 12 months, which had not progressed at 24 months and was asymptomatic. All other RSA cases showed no radiolucent lines, migration, scapular notching, or osteolysis. Three anatomic implants were converted with retention of the glenoid baseplate and humeral core to a reverse arthroplasty due to atraumatic cuff failure (N = 2) and traumatic cuff failure (N = 1). After these procedures, patients were satisfied with their results. There were no other complications.
UNASSIGNED: The 2-year results presented in this study show good functional and radiological outcomes using the SMR stemless system.