肩关节置换术中盂底板失效的非手术治疗

Q4 Medicine
Raymond E. Chen MD , Alayna K. Vaughan BS , Mark D. Lazarus MD , Gerald R. Williams MD , Surena Namdari MD, MSc
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引用次数: 0

摘要

背景:在反向全肩关节置换术(RSA)中盂底板失效仍然是一个具有挑战性的问题。非手术治疗可能是某些患者的一种选择。本研究的目的是评估RSA术后盂底板失效非手术治疗后的结果。方法利用单一机构数据库,对2010年至2019年RSA术后盂底板失效并非手术治疗的患者进行回顾性分析。排除标准包括翻修手术和存在活动性感染。纳入的患者进行了至少2年的临床和影像学随访。图表回顾记录了患者的人口统计、手术指征和技术。检查x线片以确定底板失效和其他种植体并发症的病因。在手术后和底板失效后立即在真正位x线片上测量关节球倾角。结果在研究期间,有18例患者接受了非手术治疗。5例患者死亡,剩下13例患者可进行临床随访。12例(92%)患者成功接触。平均年龄77岁,体重指数28,12例中有8例为女性。平均Charlson共病指数评分为4.1。术前美国肩肘外科医生(American Shoulder and肘关节外科医生)平均评分为43.0分,视觉模拟评分(VAS)疼痛为6.3分。在平均5.7年的随访中,患者的as评分为49.2,VAS疼痛评分为4.3,单次评估数值评价为49%,50%的患者对其结果满意。术前和最终随访的as和VAS评分相似。从食指手术到底板失效的平均时间为19个月。在18例确定的患者中,16例(89%)失败导致基底板上倾增加(7例伴有基底板螺钉断裂)。16例患者失败后关节球平均倾角(131°)显著大于初始倾角(100°),P = 0.03。另外2例失败导致底板前倾增加。18例患者中有8例(44%)在手术时进行了植骨。当比较不满意和满意的患者时,没有特定的患者特征或与满意度相关的放射学参数。结论非手术治疗盂底板失稳的疗效一般,中期随访时患者满意度为50%。这组患者的死亡率几乎是30%。因此,在特定的患者中,非手术治疗RSA底板失效可能是一个合理的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty

Background

Glenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA.

Methods

Utilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure.

Results

Eighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), P = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction.

Conclusion

Nonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.
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来源期刊
Seminars in Arthroplasty
Seminars in Arthroplasty Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
104
期刊介绍: Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.
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