人工全肩关节置换术治疗原发性和继发性盂肱关节骨关节炎的疗效研究  

Total shoulder arthroplasty for the treatment of primary or secondary osteoarthritis of the glenohumeral joint

作　　者：李奉龙[1] 姜春岩[1] 鲁谊[1] 朱以明[1] 李旭[1] 

机构地区：[1]北京积水潭医院运动医学科,北京100035

出　　处：《骨科临床与研究杂志》2016年第1期34-38,共5页Journal Of Clinical Orthopedics And Research

基　　金：北京市自然科学基金(7142074)~~

摘　　要：目的评价人工全肩关节置换术治疗原发性和继发性盂肱关节骨关节炎的临床疗效。方法回顾性研究2009年2月至2014年7月北京积水潭医院运动医学科收治并随访的22例原发性和继发性盂肱关节骨关节炎的患者资料。对比末次随访与术前的肩关节活动度、Constant评分和疼痛视觉模拟评分（VAS）。采用SPSS17．0软件对数据进行t检验。总结术后并发症发生情况。结果22例患者中，男6例，女16例；年龄（55．3±10．6）（41～73）岁。累及侧别：左7例，右15例。其中原发性盂肱关节骨关节炎10例，肱骨头缺血性坏死继发盂肱关节骨关节炎5例，创伤性骨关节炎7例。22例患者均接受人工全肩关节置换术治疗。术后获随访（45．6±19．9）（24～89）个月。末次随访肩关节活动度与术前对比均有改善：前屈上举（133．6±25．6）。VS．（97．1±26．3）°，P=0．022；体侧外旋（32．9±15．0）°vs．（14．3±12．7）°，P=0．028；内旋（第1腰椎体水平±2个椎体）V8．（第5腰椎体水平±2个椎体），P=0．003。Constant评分末次随访与术前对比：（81．3±15．0）分VS．（48．3±10．4）分，P=0．001。VAS评分末次随访与术前对比：（0．4±1．1）分vs．（4．9±2．0）分，P：0．001。二者均有所改善。患者术后第3周、6周、12周、6个月、12个月以及末次随访时行手外旋肩关节正位、侧位和腋位x线复查，2例出现假体肱骨头上移。末次随访无感染、假体松动和神经血管损伤等术后并发症发生。结论人工全肩关节置换术治疗原发性和继发性盂肱关节骨关节炎的临床疗效良好。Objective To evaluate the clinical results of total shoulder arthroplasty for the treatment of primary or secondary osteoarthritis of the glenohumeral joint. Methods Twenty-five consecutive patients with primary or secondary osteoarthritis of the glenohumeral joint underwent total shoulder arthroplasty from Feb 2009 to Jul 2014. Twenty-two patients were available for the final follow-up, and were retrospectively assessed via range of motion, Constant score, visual analogue scale（VAS） and postoperative complications. Results There were 6 men and 16 women with the age of （55.3 ＋ 10.6） years （range, 41 to 73 years）. Seven left shoulders and 15 fight shoulders were involved. There were 10 patients with primary osteoarthrifis of the glenohumeral joint, 5 patients with secondary osteoarthritis due to avascular necrosis of the humeral head, and 7 patients with traumatic osteoarthritis. Twenty-two patients were all treated with total shoulder arthroplasty. The follow-up time was （45.6±19.9 ） months （range, 24 to 89 months）. At the last follow-up, the mean forward elevation [（133.6±25.6）° vs. （97.1±26.3）°, P=0.0221, external rotation [（32.9 ±15.0）° vs. （14.3±12.7）°, P =0.0281 and internal rotation （L1 ±2 vertebrae vs. L5±2 vertebrae, P =0.003） were all significantly improved postoperatively. The mean Constant score （ 81.3±15.0 vs. 48.3±10.4, P = 0. 001 ） and VAS score （0.4±1.1 vs. 4.9±2.0 ,P =0.001 ） were all significantly improved after the surgery. AP, lateral and axillary view X-ray of shoulder were obtained respectively in 3 weeks, 6 weeks, 12 weeks, 6 months and 12 months. Superior migration of the prosthetic humeral head was found in 2 patients. No complication such as infection, prosthetic loosening or neurovascular injury were noted at the last follow-up. Conclusions Total shoulder arthroplasty for the treatment of primary or secondary osteoarthritis of the glenohumeral joint could yield good clinical results.

关 键 词：关节成形术 置换 肩关节 骨关节炎 

分 类 号：R687.4[医药卫生—骨科学]