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首页> 外文期刊>Journal of shoulder and elbow surgery >Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: The posttraumatic shoulder
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Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: The posttraumatic shoulder

机译：肱骨头置换术后修订型全肩关节置换术治疗关节盂疼痛：创伤后的肩膀

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Hypothesis: This study was conducted to test the hypothesis that patients would have improved pain and range of motion after conversion total shoulder arthroscopy but that overall outcome would be substantially affected by the need for removal of the humeral component and associated alterations of bony anatomy or soft tissue deficiencies. Materials and methods: Thirty-four patients (34 shoulders) with HHR after a proximal humeral fracture underwent revision total shoulder arthroplasty for painful glenoid arthrosis, with mean follow-up of 9.4 years (range, 2.3-20.4 years). After initial review, repeat analysis was performed based on the complexity of osseous (humeral stem revision) and soft tissue management, including rotator cuff tear, greater tuberosity resorption, malunion or nonunion, or instability. Results: Overall, patients had reduction in pain (P = .0001), and improved active abduction (P = .05) and external rotation (P = .0005). Less improvement in active abduction was documented in patients who required soft tissue management (P = .03). Results of the modified Neer rating documented 3 excellent, 9 satisfactory, and 22 unsatisfactory results (motion deficiencies in 14). Kaplan-Meier survival analysis free of repeat revision was 100% at 1 year, 96.8% at 5 years (95% confidence interval, 90%-100%), and 92.2% at 10 years (95% confidence interval, 82% to 100%). Discussion: Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary HHR for a proximal humeral fracture, with or without the need to change the humeral component. However, active motion may not improve in patients with rotator cuff tearing, a greater tuberosity nonunion, malunion, or resorption.
机译：假设：进行这项研究是为了检验以下假设，即患者在进行全肩关节镜检查后会改善疼痛和运动范围，但总体结果会因需要去除肱骨组件以及相关的骨解剖结构或软组织改变而受到很大影响组织缺陷。材料和方法：34例肱骨近端骨折后HHR患者（34例肩）因关节盂疼痛而接受了翻修全肩关节置换术，平均随访9.4年（范围2.3-20.4岁）。初步检查后，根据骨的复杂性（肱骨干翻修）和软组织处理（包括肩袖撕裂，结节吸收大，畸形或不愈合或不稳定性）进行重复分析。结果：总体而言，患者疼痛减轻（P = .0001），主动外展（P = .05）和外旋改善（P = .0005）。需要软组织处理的患者活动性外展情况改善较少（P = .03）。修改后的Neer评分结果显示3项优秀，9项令人满意和22项不令人满意的结果（14项运动不足）。无重复修订的Kaplan-Meier生存分析在1年时为100％，在5年时为96.8％（95％置信区间，90％-100％），在10年时为92.2％（95％置信区间，82％至100 ％）。讨论：全肩关节置换术可有效解决肱骨近端骨折原发性HHR后的疼痛性关节盂关节病，而无需改变肱骨组件。但是，对于肩袖撕裂，结节不愈合较大，畸形畸形或再吸收的患者，主动运动可能无法改善。

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