解剖性全肩关节置换术后小结节截骨失败的早期诊断与翻修修复

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2024-09-23 DOI:10.1053/j.sart.2024.08.004

Kevin K. Chen MD, Chuheng Xing BS, James M. Gregory MD

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引用次数: 0

摘要

小结节截骨术（LTO）在全肩关节置换术（TSA）中由于骨间愈合和现代修复技术具有相对较高的成功率。LTO修复失败与预后较差、患者满意度降低以及可能需要翻修关节置换术相关。尽管如此，很少有研究仔细检查了在先前TSA的情况下翻修LTO修复的结果。方法回顾性分析2016年至2023年由同一位外科医生进行的所有tsa，以确定所有LTO失败并进行急性翻修LTO修复的病例。收集并报告所有TSA患者的基线特征、术后并发症（包括感染）、翻修手术的需要和翻修手术的时间。所有患者在TSA术后随访至少1年，如有需要，可进行LTO翻修固定。对LTO修订队列进行亚组分析以评估潜在的危险因素。结果共166例患者行TSA合并LTO。其中，8例患者在术后平均5.7周被诊断为急性LTO衰竭，并在术后平均6.3周接受了LTO修复固定。平均随访147.9周(标准差：90.3；范围：52.1-284.9)，8名患者中有7名（87.5%）在最近的随访中表现出LTO的愈合，没有抱怨，并发症或再手术。一名患者出现假体周围感染，需要两期翻修。在整个队列中，没有患者因肩胛下肌衰竭而接受翻修肩关节置换术。结论肩胛下肌失效的早期识别对优化翻修固定效果具有重要意义。使用LTO进行肩胛下肌修复是有益的，因为它允许早期的肩胛下肌损伤的x线检查。在急性进行翻修后的LTO修复可以成功，并且可以最大限度地减少由于肩胛下肌失败而进行翻修肩关节置换术的需要。

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Early diagnosis and revision repair of lesser tuberosity osteotomy failure after anatomic total shoulder arthroplasty

Background

Lesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA.

Methods

A retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors.

Results

A total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure.

Conclusion

Early identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.

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来源期刊

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.