反肩置换与半肩置换临床疗效对比研究
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摘要
目的研究对比反式全肩关节置换与半肩关节置换术后的临床疗效。方法分析我院2014年1月至2018年6月收治的行反式全肩关节置换与半肩关节置换的老年患者,回顾性统计分析两种不同术式术后末次随访关节活动度(range of motion,ROM)、视觉模拟评分(visual analogue scale,VAS)、加州大学肩关节评分系统(university of california at losangeles,UCLA)评分、Coleman方法学评分(Coleman methodology score,CMS)以及美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form,ASES)评分。结果本次实验研究发现,末次随访时反肩关节置换术组ROM:前屈(130.56±3.09)°、外旋(38.44±2.70)°、外展(131.78±2.54)°,半肩关节置换术组ROM:前屈(104.12±7.66)°、外旋(27.06±3.93)°、外展(123.88±4.88)°;反肩关节置换术组前屈、外展及外旋均高于半肩关节置换术组,两组比较差异有统计学意义(P<0.05)。反肩关节置换术组内旋(41.67±3.39)°,半肩置换术组内旋(48.76±3.29)°;半肩关节置换术组内旋功能优于反肩关节置换术组,两组比较差异有统计学意义(P<0.05)。反肩关节置换术组术后末次随访UCLA(28.78±2.05)分、CMS(58.89±2.80)分及ASES(74.33±2.18)分,半肩关节置换术后末次随访UCLA(26.24±2.14)分、CMS(56.12±2.47)分及ASES(71.53±2.53)分;两组比较差异具有统计学意义(P<0.05),反肩关节置换术组在UCLA、CMS及ASES评分上均优于半肩关节置换术组。反肩关节置换术后末次随访VAS评分为(1.22±0.44)分,半肩关节置换术后末次随访VAS评分为(1.41±0.51)分,两组比较差异无统计学意义(P>0.05)。结论术后反式全肩关节置换功能及评分优于半肩关节置换,对于患者生活质量改善有较大帮助,但应严格掌握反式全肩关节置换手术适应证,术前应仔细综合考量。
Objective To compare the curative effects of 2operation methods of reverse shoulder arthroplasty and hemi-shoulder arthroplasty for shoulder joint dysfunction.Methods Data of patients who underwent reverse shoulder arthroplasty and hemi-shoulder arthroplasty from January 2014 to June 2018 in our hospital were collected and followed up respectively.Range of motion(ROM),Visual Analogue score(VAS),University of California at LosAngeles score(UCLA),Adjusted Constant-Murley score(CMS)and American Shoulder and Elbow Surgeons(ASES)of the last follow-up were statistically analyzed.Results In this study,we found ROM of anteflexion,extorsion and abduction in reverse shoulder arthroplasty group were(130.56±3.09)degree,(38.44±2.70)degree and(131.78±2.54)degree respectively at last follow-up,results in hemi-shoulder arthroplasty group were anteflexion(104.12±7.66)degree,extorsion(27.06±3.93)degree and abduction(123.88±4.88)degree,anteflexion,extorsion and abduction were better in reverse shoulder arthroplasty group with P<0.05.But intorsion degree was(41.67±3.39)degree in reverse shoulder arthroplasty group,with the degree of intorsion(48.76±3.29)degree in hemi-shoulder arthroplasty group,intorsion degree was relatively better in hemi-shoulder arthroplasty group with a significant P value below 0.05.The last follow-ups of UCLA,CMS and ASES in reverse shoulder arthroplasty group were(28.78±2.05),(58.89±2.80)and(74.33±2.18)correspondingly,and UCLA(26.24±2.14),CMS(56.12±2.47)and ASES(71.53±2.53)were detected in hemi-shoulder arthroplasty group,UCLA,CMSA and ASES were higher in reverse shoulder arthroplasty group through statistical analyses(P<0.05).But VAS scores in reverse shoulder arthroplasty group and in hemi-shoulder arthroplasty group were(1.22±0.44)and(1.41±0.51),which made VAS scores had no difference in comparison,with a pvalue above0.05.Conclusion Reverse shoulder arthroplasty had relatively better postoperative shoulder function than hemi-shoulder arthroplasty method,it could enhance and improve the quality of patients`life,but this method should hold strict indications and treat it seriously.
Objective To compare the curative effects of 2operation methods of reverse shoulder arthroplasty and hemi-shoulder arthroplasty for shoulder joint dysfunction.Methods Data of patients who underwent reverse shoulder arthroplasty and hemi-shoulder arthroplasty from January 2014 to June 2018 in our hospital were collected and followed up respectively.Range of motion(ROM),Visual Analogue score(VAS),University of California at LosAngeles score(UCLA),Adjusted Constant-Murley score(CMS)and American Shoulder and Elbow Surgeons(ASES)of the last follow-up were statistically analyzed.Results In this study,we found ROM of anteflexion,extorsion and abduction in reverse shoulder arthroplasty group were(130.56±3.09)degree,(38.44±2.70)degree and(131.78±2.54)degree respectively at last follow-up,results in hemi-shoulder arthroplasty group were anteflexion(104.12±7.66)degree,extorsion(27.06±3.93)degree and abduction(123.88±4.88)degree,anteflexion,extorsion and abduction were better in reverse shoulder arthroplasty group with P<0.05.But intorsion degree was(41.67±3.39)degree in reverse shoulder arthroplasty group,with the degree of intorsion(48.76±3.29)degree in hemi-shoulder arthroplasty group,intorsion degree was relatively better in hemi-shoulder arthroplasty group with a significant P value below 0.05.The last follow-ups of UCLA,CMS and ASES in reverse shoulder arthroplasty group were(28.78±2.05),(58.89±2.80)and(74.33±2.18)correspondingly,and UCLA(26.24±2.14),CMS(56.12±2.47)and ASES(71.53±2.53)were detected in hemi-shoulder arthroplasty group,UCLA,CMSA and ASES were higher in reverse shoulder arthroplasty group through statistical analyses(P<0.05).But VAS scores in reverse shoulder arthroplasty group and in hemi-shoulder arthroplasty group were(1.22±0.44)and(1.41±0.51),which made VAS scores had no difference in comparison,with a pvalue above0.05.Conclusion Reverse shoulder arthroplasty had relatively better postoperative shoulder function than hemi-shoulder arthroplasty method,it could enhance and improve the quality of patients`life,but this method should hold strict indications and treat it seriously.
引文
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[2] Lignel A,Berhouet J,Loirat MA,et al.Reverse shoulder arthroplasty for proximal humerus fractures:Is the glenoid implant problematic?[J].Orthop Traumatol Surg Res,2018,104(6):773-777.
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[5] Irlenbusch U,Blatter G,Gebhardt K,et al.Prospective study of double-eccentric hemi shoulder arthroplasty in different aetiologies:midterm results[J].Int Orthop,2011,35(7):1015-1023.
[6] Werthel JD,Sirveaux F,Block D.Reverse shoulder arthroplasty in recent proximal humerus fractures[J].Orthop Traumatol Surg Res,2018,104(6):779-785.
[7]戈允申,陈世益.肩关节功能评分系统的现状和展望[J].中华骨科杂志,2007,27(10):786-789.
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[10]陆博,Scarlat MM.反置式肩关节成形术:择期手术的当前趋势[J].中华骨科杂志,2018,38(10):627-634.
[11]韩晓珺,戚文潇,方朝毅,等.反置式全肩关节置换术治疗巨大不可修复性肩袖损伤研究进展[J].国际骨科学杂志,2017,38(6):341-344.
[12]戴海峰,刘凤,李嘉,等.3种手术方式治疗老年肱骨近端复杂骨折临床疗效的对比研究[J].医学研究生学报,2018,31(7):734-738.
[13] Ascione F,Kilian CM,Laughlin MS,et al.Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem:an analysis of 485consecutive cases[J].J Shoulder Elbow Surg,2018,27(12):2183-2190.
[14] Chae J,Siljander M,Wiater JM.Instability in reverse total shoulder arthroplasty[J].J Am Acad Orthop Surg,2018,26(17):587-596.
[15] Werner BS,Chaoui J,Walch G.Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty[J].Bone Joint J,2018,100(9):1182-1186.
[16] Ohl X,Bonnevialle N,Gallinet D,et al.How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures[J].J Shoulder Elbow Surg,2018,27(12):2139-2144.
[17] Ferrier A,Blasco L,Marcoin A,et al.Geometric modification of the humeral position after total reverse shoulder arthroplasty:what is the optimal lowering of the humerus?[J].J Shoulder Elbow Surg,2018,27(12):2207-2213.
[18] Romano AM,Oliva F,Nastrucci G,et al.Reverse shoulder arthroplasty patient personalized rehabilitation protocol.Preliminary results according to prognostic groups[J].Muscles Ligaments Tendons J,2017,7(2):263-270.
[19] Uschok S,Herrmann S,Pauly S,et al.Reverse shoulder arthroplasty:the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up[J].Arch Orthop Trauma Surg,2018,138(12):1647-1652.
[2] Lignel A,Berhouet J,Loirat MA,et al.Reverse shoulder arthroplasty for proximal humerus fractures:Is the glenoid implant problematic?[J].Orthop Traumatol Surg Res,2018,104(6):773-777.
[3] Grosel TW,Plummer DR,Mayerson JL,et al.Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis[J].J Surg Oncol,2018,118(6):867-872.
[4] Leroux TS,Basques BA,Saltzman BM,et al.Shoulder arthroplasty in patients with rheumatoid arthritis:A population-based study examining utilization,adverse events,length of stay,and cost[J].Am J Orthop(Belle Mead NJ),2018,47(6):1-12.
[5] Irlenbusch U,Blatter G,Gebhardt K,et al.Prospective study of double-eccentric hemi shoulder arthroplasty in different aetiologies:midterm results[J].Int Orthop,2011,35(7):1015-1023.
[6] Werthel JD,Sirveaux F,Block D.Reverse shoulder arthroplasty in recent proximal humerus fractures[J].Orthop Traumatol Surg Res,2018,104(6):779-785.
[7]戈允申,陈世益.肩关节功能评分系统的现状和展望[J].中华骨科杂志,2007,27(10):786-789.
[8]戴海峰,李嘉,刘凤,等.反置式全肩关节置换治疗肱骨头坏死近期临床疗效观察[J].中国矫形外科杂志,2016,24(21):2000-2003.
[9] Chalmers PN,Salazar DH,Romeo AA,et al.Comparative utilization of reverse and anatomic total shoulder arthroplasty:A comprehensive analysis of a high-volume center[J].J Am Acad Orthop Surg,2018,26(24):e504-e510.
[10]陆博,Scarlat MM.反置式肩关节成形术:择期手术的当前趋势[J].中华骨科杂志,2018,38(10):627-634.
[11]韩晓珺,戚文潇,方朝毅,等.反置式全肩关节置换术治疗巨大不可修复性肩袖损伤研究进展[J].国际骨科学杂志,2017,38(6):341-344.
[12]戴海峰,刘凤,李嘉,等.3种手术方式治疗老年肱骨近端复杂骨折临床疗效的对比研究[J].医学研究生学报,2018,31(7):734-738.
[13] Ascione F,Kilian CM,Laughlin MS,et al.Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem:an analysis of 485consecutive cases[J].J Shoulder Elbow Surg,2018,27(12):2183-2190.
[14] Chae J,Siljander M,Wiater JM.Instability in reverse total shoulder arthroplasty[J].J Am Acad Orthop Surg,2018,26(17):587-596.
[15] Werner BS,Chaoui J,Walch G.Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty[J].Bone Joint J,2018,100(9):1182-1186.
[16] Ohl X,Bonnevialle N,Gallinet D,et al.How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures[J].J Shoulder Elbow Surg,2018,27(12):2139-2144.
[17] Ferrier A,Blasco L,Marcoin A,et al.Geometric modification of the humeral position after total reverse shoulder arthroplasty:what is the optimal lowering of the humerus?[J].J Shoulder Elbow Surg,2018,27(12):2207-2213.
[18] Romano AM,Oliva F,Nastrucci G,et al.Reverse shoulder arthroplasty patient personalized rehabilitation protocol.Preliminary results according to prognostic groups[J].Muscles Ligaments Tendons J,2017,7(2):263-270.
[19] Uschok S,Herrmann S,Pauly S,et al.Reverse shoulder arthroplasty:the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up[J].Arch Orthop Trauma Surg,2018,138(12):1647-1652.