肩关节反向置换术后的内旋恢复可能因病因不同而异：一项多中心回顾性研究

IF 2.7 Q1 ORTHOPEDICS Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-08-01 DOI:10.1016/j.jisako.2024.05.016

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引用次数: 0

摘要

背景：反向肩关节置换术（RSA）为年轻患者带来了良好的功能效果，但在恢复内旋（IR）方面仍存在挑战。本研究旨在评估60岁以下患者RSA术后内旋的恢复情况，并分析影响内旋恢复的因素：本研究进行了一项回顾性多中心研究，考察了接受RSA手术的患者的功能恢复情况，随访时间至少为2年。对接受初级 RSA 的两个亚组患者的活动能力（AIR1）分别进行了分析："结果：研究包括 136 名患者（整体系列），平均年龄为 51.6 岁。总体系列患者的主动活动范围（RoM）、疼痛和 Constant 评分均有明显改善，尤其是主动 IR 患者（P0.05）。在亚组分析中，易患 AIR1 的患者体质指数明显降低，康斯坦茨评分活动度明显提高，向前抬高和主动 IR 的活动度也有所改善（P结论：RSA可改善60岁以下患者的主动RoM、疼痛和功能预后。然而，IR的改善程度可能因多种因素和潜在病因而异。这些见解对患者的选择和咨询至关重要，可指导 RSA 的优化工作：证据等级：IV。

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Restoration of internal rotation after reverse shoulder arthroplasty may vary depending on etiology in patients younger than 60 years of age: a multicenter retrospective study

Background

Reverse shoulder arthroplasty (RSA) offers promising functional outcomes for young patients, yet challenges persist in restoring internal rotation (IR). This study aimed to assess the restoration of IR after RSA in patients younger than 60 years of age and analyze the factors affecting IR recovery.

Methods

A retrospective multicenter study was conducted, examining the functional outcome of patients who underwent RSA, with a minimum follow-up period of 2 years. Two subgroups of patients who underwent primary RSA were analyzed separately with respect to active internal rotation with the elbow at the side (AIR1): “difficult AIR1” and “easy AIR1.”

Results

The study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active IR (p < 0.01). According to etiology, statistically significant improvement (p < 0.05) in active IR was observed for fracture sequelae, primary osteoarthritis, and rheumatoid arthritis, whereas no statistically significant improvement in IR was observed for tumor, revision, and cuff-tear arthropathy (p > 0.05). In subgroup analysis, patients with easy AIR1 displayed a statistically significant lower body mass index and better Constant score mobility, as well as improved motion in forward elevation and active IR (p < 0.05). No statistically significant associations were found between improved IR and prosthetic design or subscapularis repair. Scapular notch, lysis of the graft, and teres minor atrophy were significantly associated with better active IR (p < 0.05).

Conclusion

RSA improves active RoM, pain, and functional outcomes in patients aged under 60. However, the degree of improvement in IR may vary depending on several factors and the underlying etiologies. These insights are crucial for patient selection and counseling, guiding RSA optimization efforts.