JBJS：肱盂关节骨性关节炎采用半肩关节置换的长期随访结果

对于严重肱盂关节骨性关节炎的手术治疗而言，采用全肩关节置换还是半肩关节置换，目前尚存有争议，相关病例采用伴肩关节的长期临床效果也缺乏相关研究报道。最近，美国哥伦比亚大学医学院肩肘外科及运动医学研究中心的William N。 Levine， MD等实施了一项临床观察研究，对肩关节骨性关节炎患者采用半肩关节置换的长期临床效果进行了考察，并于近日在J Bone Joint Surg Am上发表了其研究论文。

该研究队列共包括因肱盂关节骨性关节炎而实施半肩关节置换治疗的患者30例（31肩），所有患者均就诊治疗于作者所在医疗中心。共有25例患者获得最终随访，5例死亡，1例拒绝参与该研究。5例死亡病例中3例在生前接受了肩关节翻修手术，因此，这3例死亡患者的随访结果也被纳入最终的研究数据中。最终，该研究中包括27例患者（28肩）。随访方式包括电话交谈，邮件调查等。随访中采用的评估措施为简明量表-36（Short Form-36，SF-36），美国肩肘外科医师(American Shoulder and Elbow Surgeons，ASES)肩关节疗效评分，EuroQol评分，Simple肩关节试验，改良Neer评分以及自我管理运动活动范围调查表等。另外，通过统计分析对临床效果与年龄、关节盂磨损类型以及骨性关节炎病因之间的相关性进行评估。

研究结果显示，平均随访时间为17。2年（13-21年）；随访期内共有8例患者实施了假体翻修手术，其中同心圆关节盂15肩中占3肩，偏心圆关节盂16肩中占5肩。对于未实施翻修手术的患者，其平均ASES肩关节疗效评分为70。54分(范围，36。67 -91。67分)。总体上，肩关节外展90°下，患者的肩关节主动前屈和外旋活动度分别由术前的104°和20。7°增加到末次随访时的141。8°(范围，45°-180°)和61。0°(范围，30°-90°)(p < 0。05)。需要实施假体翻修的病例，其手术时的平均年龄为57。1岁（范围，27-63岁）。所有病例的总体Neer满意率为25%。在未实施假体翻修的患者中，关节盂同心圆磨损病例的平均Neer评分和Neer满意率显着高于偏心圆磨损者(p = 0。015；p = 0。001)。关节盂同心圆磨损的患者其EuroQol评分显着更高(p = 0。020)。原发性肩骨性关节炎患者的平均Neer评分为65。29分(范围，47-78分)，而继发性肩骨性关节炎患者为54。46分(范围，40-77分)，差异有统计学意义(p = 0。036)。

该研究结果表明，肱盂关节骨性关节炎患者采用半肩关节置换手术治疗后平均17年随访，只有25%的病例临床效果满意。相比关节盂偏心圆磨损和继发性肩骨性关节炎患者，关节盂同心圆磨损和原发性肩骨性关节炎患者的临床效果更佳，但随着时间的延长，这些患者的临床效果均会显着降低。(生物谷Bioon.com)

与关节置换相关的拓展阅读：

• JBJS：肱盂关节骨性关节炎采用半肩关节置换的长期随访结果
• CORR：全髋关节置换在老年股骨颈囊内移位骨折中的应用
• J Arthroplasty：全髋关节置换术后2-4年骨盆倾斜角的变化
• FDA讨论金属对金属髋关节置换安全性
• AAOS：金对金全髋关节置换失败情况及翻修适应症
更多信息请点击：有关关节置换更多资讯

doi: 10.2106/JBJS.K.00603.
PMC:
PMID:

Long-Term Follow-up of Shoulder Hemiarthroplasty for Glenohumeral Osteoarthritis.

Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU.

BACKGROUND:There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking. METHODS:Of a cohort of thirty patients (thirty-one shoulders) who were treated with hemiarthroplasty for glenohumeral osteoarthritis and followed longitudinally at our institution, twenty-five were available for long-term follow-up; five died, and one refused to participate. Three of the five patients who died had revision arthroplasty before death, and the data from those three were therefore included in the final follow-up (final follow-up data therefore included twenty-seven patients and twenty-eight shoulders). Follow-up through phone conversations and postal mail surveys included the following: Short Form-36, American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, EuroQol, Simple Shoulder Test, modified Neer Score, and a unique, validated self-administered range-of-motion questionnaire. Correlations between clinical outcome and age, type of glenoid wear, and cause of osteoarthritis were determined. RESULTS:The average follow-up was 17.2 years (range, thirteen to twenty-one years). There were eight revisions (three of fifteen shoulders with concentric glenoids, and five of sixteen shoulders with eccentric glenoids). For those shoulders not revised, the average ASES score was 70.54 (range, 36.67 to 91.67). Overall, active shoulder forward elevation and external rotation with the arm at 90° of abduction increased from 104° preoperatively to 141.8° (range, 45° to 180°) and 20.7° to 61.0° (range, 30° to 90°), respectively (p < 0.05), at the time of final follow-up. Of those who required revision arthroplasty, the average patient age at the time of the index procedure was 51.0 years (range, twenty-six to eighty-one years), while those not requiring revision averaged 57.1 years (range, twenty-seven to sixty-three years). The overall Neer satisfaction rating was 25%. The average Neer score and Neer rating for unrevised cases were significantly higher for concentric glenoid wear compared with eccentric glenoid wear (p = 0.015 and p = 0.001, respectively). Patients who had concentric glenoid wear had higher EuroQol scores (p = 0.020). The average Neer scores were 65.29 (range, forty-seven to seventy-eight) for primary osteoarthritis and 54.46 (range, forty to seventy-seven) for secondary osteoarthritis (p = 0.036). CONCLUSIONS:Only 25% of patients with glenohumeral osteoarthritis treated with shoulder hemiarthroplasty are satisfied with their outcome at an average of seventeen years after the operation. Patients with concentric glenoid wear and primary osteoarthritis have better outcomes than those with eccentric glenoid wear and secondary osteoarthritis do, but patients in both groups experienced deterioration of results over time. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

(责任编辑：haozongdi)