Theresa Pak, Ali I Kilic, Javier Ardebol, Reuben Gobezie, Benjamin W Sears, Evan Lederman, Brian C Werner, Patrick J Denard
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引用次数: 0
Abstract
Background: The incidence of scapular notching has dramatically reduced with the shift from 155° to 135° humeral inclination in reverse shoulder arthroplasty (rTSA). However, humeral inclination is not the only factor as notching persists with medialized glenospheres. The purpose of this study was to assess the effect of glenoid-sided lateralization on scapular notching with a 135° rTSA.
Methods: A retrospective review was performed from a multicenter prospectively collected database to identify patients who underwent primary rTSA and had 2 year minimum follow-up. All rTSAs were performed with the Arthrex system using a 135° inlay humeral component. Varying amounts of glenoid-sided lateralization were used from 0 to 8 mm in 2 mm increments based on surgeon preference. Postoperative radiographs were evaluated for scapular notching, distalization shoulder angle (DSA), and lateralization shoulder angle (LSA). The LSA was further subdivided into humeral (HLA) and glenoid (GLA) contributions. Regression analysis was performed on component and clinical variables to assess for factors predictive of notching and the effect on clinical outcomes.
Results: Overall, scapular notching was observed in 56 out of 517 shoulders (10.8%). Metallic glenoid lateralization and glenosphere overhang were protective of notching (P = .030, P = <.001; respectively). For women, 6 mm of lateralization reduced notching compared to 4 mm or less (5.3% vs. 15.6%; P = .016). For men, 8 mm of lateralization reduced notching compared to 6 mm or less but the difference did not meet statistical significance (7.6% vs. 13.6%; P = .161). Notching also was associated with decreased forward flexion by 13° (β -12.79, 95% CI: -19.63 - -5.96 P = <.001).
Discussion: With a 135° inlay humerus and lateralized glenoid rTSA, scapular notching decreases with metallic lateralization of 6 mm or more. Additionally, inferior glenosphere positioning is protective of notching. Notching is associated with worse clinical outcomes and lower postoperative ROM.
Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study.
背景：在反向肩关节置换术（rTSA）中，肩胛骨切迹的发生率随着肱骨倾角从155°变为135°而显著降低。然而，肱骨倾斜并不是唯一的因素，因为缺口持续存在于中度关节球。本研究的目的是评估135°rTSA肩胛骨侧偏对切迹的影响。方法：从多中心前瞻性收集的数据库中进行回顾性研究，以确定接受原发性rTSA并进行至少2年随访的患者。所有rtsa均采用135°内嵌肱骨假体的Arthrex系统进行。根据外科医生的喜好，以2毫米的增量从0到8毫米使用不同量的肩关节侧偏。术后x线片评估肩胛骨切迹、远端肩关节角（DSA）和侧侧肩关节角（LSA）。LSA进一步细分为肱骨（HLA）和肩关节（GLA）贡献。对各组成变量和临床变量进行回归分析，以评估切痕的预测因素及其对临床结果的影响。结果：总体而言，517例肩胛骨切口中有56例（10.8%）。金属关节盂外侧化和关节盂悬垂对切迹有保护作用（P = 0.030, P =）讨论：肱骨135°内嵌和关节盂外侧化rTSA，金属关节盂外侧化6mm或以上，肩胛骨切迹减少。此外，下盂球定位是保护缺口。切口与较差的临床结果和较低的术后rom相关。证据水平：III级；回顾性队列比较；预后研究。
期刊介绍：
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
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