解剖全肩关节置换术与反向肩关节置换术治疗肩关节后盂磨损的比较分析。

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-02-01 DOI:10.1016/j.jcot.2024.102868

Austin Hardaway , Andrew Renshaw , Tyler Brolin , David Bernholt , Frederick Azar , Thomas Throckmorton

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引用次数: 0

摘要

简介：反向肩关节置换术（RSA）和解剖全肩关节置换术（TSA）是众所周知的治疗肩关节关节炎的方法，这通常导致肩关节后部磨损。该研究比较了采用RSA和TSA治疗Walch B2和B3型关节盂的患者至少两年的结果。方法：38肩接受TSA和40肩接受RSA由两名奖学金培训的肩关节外科医生在三级转诊中心。结果：RSA组和TSA组的平均随访时间分别为25.9个月和25.5个月（P = 0.47）。RSA组由27名男性和13名女性组成；而TSA组有37名男性和1名女性（P = P = P = 0.003），内旋(60°vs 52°；p = 0.002)。主动前抬高无显著性差异。TSA组术后并发症7例（18.4%），RSA组术后并发症3例（7.5%）（P = 0.27）。最常见的并发症是头静脉血栓形成。没有并发症需要修改。结论：肩骨关节炎和肩关节后盂磨损且肩袖完整的患者接受TSA治疗的结果与RSA相似。与RSA组相比，TSA组术后2年的主动外旋和内旋均优于RSA组，但2年的主动正向抬高是相等的。两组在所有层面和所有三种临床结果评分系统中，2年的力量结果相似。TSA组术后并发症发生率较高。两组都不需要再手术。这些结果表明，TSA和RSA可以安全地用于后盂磨型，具有良好的临床效果。证据等级:三级;回顾性队列研究。

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A comparative analysis of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty for posterior glenoid wear patterns

Introduction

Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are well-known methods of treating glenohumeral arthritis, which often leads to posterior wear of the glenoid. This study compared minimum two-year outcome measures in patients treated with RSA and TSA for Walch B2 and B3 glenoids.

Methods

Thirty-eight shoulders underwent TSA and 40 shoulders underwent RSA by two fellowship-trained shoulder surgeons at a tertiary referral center.

Results

The mean time for follow-up was 25.9 months and 25.5 months for RSA and TSA groups, respectively (P = 0.47). The RSA group consisted of 27 males and 13 females; whereas the TSA group had 37 males and 1 female (P = <0.001). The mean age for RSA was 71 years old, 61 years for TSA (P = <0.001). TSA patients demonstrated superior average active external rotation (47° vs 40°; P = 0.003) and internal rotation (60° vs 52°; P = 0.002). Active forward elevation did not significantly differ. The TSA group had 7 (18.4 %) postoperative complications, the RSA group had 3 (7.5 %) (P = 0.27). The most common complication was cephalic vein thrombosis. No complication required revision.

Conclusions

Patients with shoulder osteoarthritis and posterior glenoid wear patterns with an intact rotator cuff who underwent TSA had similar outcomes as RSA. While the TSA group had superior active external rotation and internal rotation at 2 years postoperative compared with RSA, the 2-year active forward elevation was equivalent. Both groups had similar 2-year outcomes for strength in all planes and in all three clinical-outcome scoring systems. The TSA group demonstrated a higher incidence of postoperative complications. Neither group required reoperations. These results indicate that TSA and RSA can be safely utilized in posterior glenoid wear patterns with good clinical outcomes.

Level of evidence

Level III; Retrospective cohort study.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.