反式全肩关节置换治疗盂肱关节骨关节炎伴巨大肩袖撕裂  

Short-term efficacy of reverse total shoulder arthroplasty for glenohumeral osteoarthritis with massive rotator cuff tears

作　　者：王庆 黄华扬 张涛 贾震宇 沈洪园 区永亮 孔令闯 Wang Qing;Huang Huayang;Zhang Tao;Jia Zhenyu;Shen Hongyuan;Ou Yongliang;Kong Lingchuang(Department of Orthopaedic Surgery, Institute of Traumatic Orthopaedics of PLA, Guangdong Key Lab of Orthopedic Technology and Implant, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, China)

机构地区：[1]中国人民解放军南部战区总医院骨科医院,全军创伤骨科研究所,广东省骨科矫形技术及植入材料重点实验室,全军热区创伤救治与组织修复重点实验室,广州510010

出　　处：《中华关节外科杂志（电子版）》2020年第3期266-273,共8页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：中国博士后科学基金(2018M643893);广东省科技计划项目(2017B030314139);广州市科技计划项目(201904010315)。

摘　　要：目的探讨反式全肩关节置换术治疗盂肱关节骨关节炎合并巨大肩袖撕裂的近期临床疗效。方法回顾性分析2016年1月至2018年12月在南部战区总医院接受初次反式全肩关节置换术治疗的15例盂肱关节骨关节炎合并巨大肩袖撕裂患者,均有肩关节持续性疼痛、功能障碍,且三角肌无损伤具有功能;排除有臂丛或腋神经损伤以及有肩关节手术史的患者。评估其术前、术后1年的肩关节主动活动度,使用美国肩肘外科协会(ASES)肩关节评分、加州大学洛杉矶分校(UCLA)最终结果评分评价肩关节功能,分析X线及CT并发症出现情况。采用配对t检验对术前及术后的活动度和评分差异进行性分析。结果15例患者均顺利完成手术并获得随访,随访时间17个月(范围12~36个月)。反式全肩关节置换术后1年肩关节主动前屈(124±11)°较术前(58±18)°提高(t=14.316,P<0.01),外展(120±12)°较术前(58±20)°提高(t=9.959,P<0.01),内旋较术前改善,外旋(26±8)°较术前(25±9)°无明显变化(t=1.598,P>0.05),术后1年ASES评分(78±7)显著高于术前(33±8)(t=16.487,P<0.01);术后1年UCLA评分(31±4)显著高于术前(15±3)(t=12.826,P<0.01)。结论RTSA能够有效治疗盂肱关节骨关节炎合并巨大肩袖撕裂,取得了良好的早期临床效果,但术后肩关节外旋无明显改善,术前需评价小圆肌情况以确定相关治疗方案。Objective To investigate the short-term clinical efficacy of reverse total shoulder arthroplasty(RTSA)in the treatment of glenohumeral osteoarthritis(GHOA)with massive rotator cuff tears(MRCT).Methods A retrospective analysis was performed on 15 glenohumeral osteoarthritis patients complicated with massive rotator cuff tears underwent primary reverse total shoulder arthroplasty from January 2016 to December 2018 at General Hospital of Southern Theater Command.All the patients had persistent shoulder pain,dysfunction,and no damage to the deltoid muscle.The active range of motion(ROM)of shoulder was evaluated preoperatively and postoperatively(six months and one year).American Association of Shoulder and Elbow Surgery(ASES)shoulder score and University Of California at Los Angeles(UCLA)score were used to evaluate shoulder function.The X-ray and CT scan were used to assess the prevalence of surgery-related complications.ROM and evaluation scores were analyzed by t test.Results All 15 patients completed the operation successfully and were followed up for 17 months(range 12~36 months).one year after reverse total shoulder arthroplasty,active shoulder elevation(124±11)°was higher than preoperative(58±18)°(t=14.316,P<0.01),abduction(120±12)°was higher than preoperative(58±20)°(t=9.959,P<0.01),and internal rotation was better than preoperative.But there was no significant change in the active level of external rotation postoperative(26±8)°compared with preoperative(25±9)°(t=1.598,P>0.05).The ASES score(78±7)postoperative was significantly higher than that preoperative(33±8)(t=16.487,P<0.01),and the UCLA score postoperative(31±4)was significantly higher than that preoperative(15±3)(t=12.826,P<0.01).Conclusions GHOA with MRCT can be effectively treated with RTSA,which has achieved good early clinical results.However,there is no significant improvement in shoulder external rotation after surgery.It is necessary to evaluate the condition ofteres minor preoperatively.

关 键 词：肩关节 骨关节炎 回旋套 关节成形术 

分 类 号：R68[医药卫生—骨科学]