Matthias Bülhoff, Amina Gurda, Johannes Weishorn, David Spranz, Kevin Knappe, Patric Raiss, Raphael Trefzer
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Radiographs were evaluated for glenoid erosion, Walch glenoid types as well as signs of implant loosening. Statistical comparison was performed using students t-tests with a significance level set to p < 0.05.</p><p><strong>Results: </strong>Seventeen shoulders were retrospectively included in the implant survival analysis. Two patients underwent revision surgery. five patients died with the implant and were therefore censored. Cumulative survival rate was 100% after ten years and 93.3% after 15 years. Seven shoulders were available for clinical and radiological evaluation at a mean follow-up of 19 years (range 17-22 years). Age- and sex-adjusted CMS improved from preoperative to the latest follow-up (44.4% vs. 82.9%; p < 0.01). No glenoid erosion of higher degree (Sperling grade > 2) and no signs of implant loosening were observed. 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引用次数: 0
摘要
目的：肱骨头骨坏死（HHN）是一种关节破坏疾病，无骨水泥肱骨头置换（CHHR）提供了一种保骨治疗选择。本研究的目的是报告HHN患者CHHR的长期预后和种植体存活率。方法：回顾性分析2004 ~ 2007年行无骨水泥肱骨头置换术（CHHR）治疗的肱骨头坏死患者。根据Kaplan-Meier分析评估种植体存活。临床评价包括Constant-Murley-Score （CMS）、Simple Shoulder Test （SST）、Subjective Shoulder Value （SSV）和以患者为中心的满意度和生活质量。x线片评估关节盂糜烂，Walch关节盂类型以及假体松动的迹象。采用学生t检验进行统计学比较，显著性水平为p。结果：17个肩部回顾性纳入植入物生存分析。2例患者接受了翻修手术。5名患者死于植入物，因此被审查。10年累计生存率为100%，15年累计生存率为93.3%。在平均随访19年（17-22年）期间，有7个肩关节可用于临床和放射学评估。从术前到最新随访，年龄和性别调整的CMS有所改善（44.4% vs. 82.9%; p 2），未观察到植入物松动的迹象。所有患者术前均有Walch型A型肩关节。结论：在这个17-22年长期随访的小队列中，CHHR在精心挑选的患者中显示出良好的耐久性和功能预后。证据级别：IV级病例系列，无对照组。
Long-term results of cementless humeral head resurfacing for humeral head osteonecrosis - a monocentric longitudinal observational study.
Purpose: Humeral head osteonecrosis (HHN) is a joint-destructive condition, for which cementless humeral head resurfacing (CHHR) offers a bone-preserving treatment option. The aim of this study was to report long-term outcomes and implant survival of CHHR in patients with HHN.
Methods: Patients with humeral head osteonecrosis treated with cementless humeral head resurfacing (CHHR) between 2004 and 2007 were included. Implant survival was assessed according to Kaplan-Meier analysis. Clinical evaluation included Constant-Murley-Score (CMS), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV) and patient centered outcomes regarding satisfaction and quality of life. Radiographs were evaluated for glenoid erosion, Walch glenoid types as well as signs of implant loosening. Statistical comparison was performed using students t-tests with a significance level set to p < 0.05.
Results: Seventeen shoulders were retrospectively included in the implant survival analysis. Two patients underwent revision surgery. five patients died with the implant and were therefore censored. Cumulative survival rate was 100% after ten years and 93.3% after 15 years. Seven shoulders were available for clinical and radiological evaluation at a mean follow-up of 19 years (range 17-22 years). Age- and sex-adjusted CMS improved from preoperative to the latest follow-up (44.4% vs. 82.9%; p < 0.01). No glenoid erosion of higher degree (Sperling grade > 2) and no signs of implant loosening were observed. All patients had Walch type A glenoids preoperatively.
Conclusion: In this small cohort with long-term follow-up of 17-22 years, CHHR showed promising durability and functional outcomes in carefully selected patients.
Level of evidence: Level IV Case series with no comparison group.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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