反向肩关节置换术中盂底钢板内侧化与外侧化：对临床结果和功能表现的影响：一项系统回顾和荟萃分析

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2025-05-27 DOI:10.1053/j.sart.2025.04.011

James G. Kelly MB, BCh, BAO , Thomas Deane MB, BCh, BAO , Andrew Kelly MB, BCh, BAO , Conor McNamee MB, BCh, BAO , Stefan Bauer MD , William Blakeney MBBS, MS, MSc, FRACS

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引用次数: 0

摘要

背景：在反向肩关节置换术（RSA）中，旋转中心（COR）的侧化已被提出用于对抗肩胛骨缺口并改善功能预后。通过增加关节盂底板外侧偏移量可以实现COR的侧化。本综述的目的是比较肩胛基底板侧化与中化对原发性RSA的预后、肩胛骨切迹和并发症发生率的影响。方法按照系统评价和荟萃分析指南首选报告项目进行系统评价和荟萃分析。2023年12月对PubMed、EMBASE和Cochrane Library进行关键词检索。该搜索提供了908项研究。经过两位独立作者的审查，12例符合纳入标准并符合meta分析的资格。结果荟萃分析显示，侧化盂底钢板组肩胛骨切迹明显减少。侧化组有改善外旋的趋势（平均差= 4.86）；然而，这种差异没有达到显著性（P = .067）。两组之间在功能结局、活动范围或并发症方面没有其他显著差异。四项研究的亚组分析显示，侧化组的美国肩关节外科医生的表现明显低于侧化组（P = 0.018），其中中化组为中化组，而侧化组为侧化组，而侧化组为侧化组。平均随访31.1个月。结论：与中位盂底板相比，肩胛骨侧移位可显著减少肩胛骨切迹，在功能结果、活动范围或并发症方面无显著差异。该研究显示，美国肩肘外科医生在钢板和椎体侧化组的评分明显低于中位钢板和椎体侧化组。RSA中COR的侧化仍然是一个相对较新的概念，需要进一步的研究，分离肩关节和肱骨变量，随访时间更长，以评估长期功能结局和并发症发生率。

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Medialization vs. lateralization of the glenoid baseplate in reverse shoulder arthroplasty: implications for clinical outcomes and functional performance: a systematic review and meta-analysis

Background

Lateralization of the center of rotation (COR) in reverse shoulder arthroplasty (RSA) has been proposed to combat scapular notching and improve functional outcomes. Lateralizing the COR can be achieved by increasing the glenoid baseplate lateral offset. The aim of this review was to compare the effect of lateralization vs. medialization of the glenoid baseplate on outcomes, scapular notching, and complication rate in primary RSA.

Methods

A systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of PubMed, EMBASE, and Cochrane Library using keywords was undertaken in December 2023. The search provided 908 studies. After review by two independent authors, 12 met the inclusion criteria and qualified for meta-analysis.

Results

Meta-analysis showed a significant decrease in scapular notching in the lateralized glenoid baseplate group. There was a trend towards improved external rotation in the lateralized group (mean difference = 4.86); however, this difference did not reach significance (P = .067). No other significant difference in functional outcomes, range of motion, or complications was observed between the two groups. A subgroup analysis of four studies that contained a medialized baseplate and lateralized stem as the medialized group vs. lateralized baseplate with lateralized stem as the lateralized group showed significantly inferior American Shoulder and Elbow Surgeons in the lateralized group (P = .018). The mean follow-up period was 31.1 months.

Conclusion

Lateralization of the glenoid component results in a significant decrease in scapular notching, with no significant difference in functional outcomes, range of motion, or complications compared to a medialized glenoid baseplate. The study showed significantly inferior American Shoulder and Elbow Surgeons scores amongst those lateralized at both baseplate and stem vs. those with a medialized baseplate and lateralized stem. Lateralization of the COR in RSA is still a relatively novel concept, and further studies are required, isolating the glenoid and the humeral variables, with longer follow-up periods, to assess long-term functional outcomes and complication rates.

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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.