对于患有盂肱骨关节炎和完整肩袖的解剖型或反向全肩关节置换术患者,术前前倾无力是否会影响临床效果?

IF 1.8 Q2 ORTHOPEDICS Clinics in Shoulder and Elbow Pub Date : 2024-09-01 Epub Date: 2024-07-30 DOI:10.5397/cise.2024.00262
Keegan M Hones, Kevin A Hao, Timothy R Buchanan, Amy P Trammell, Jonathan O Wright, Thomas W Wright, Tyler J LaMonica, Bradley S Schoch, Joseph J King
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引用次数: 0

摘要

背景:本研究旨在确定术前前倾(FE)无力是否会影响肩袖未触及的盂肱骨关节炎(RCI-GHOA)患者的解剖型(aTSA)和反向全肩关节置换术(rTSA)的结果:我们对一家医疗机构在2007年至2020年间收集的前瞻性肩关节置换术数据库进行了回顾性研究,其中包括333例至少随访2年的原发性RCI-GHOA的aTSA和155例rTSA。将术前虚弱定义为 FE 力量≤4.9 磅,按年龄、性别和随访情况以 1:1:1 的比例匹配三个队列:虚弱(n=82)与正常 aTSAs、虚弱(n=44)与正常 rTSAs、虚弱 aTSAs(n=61)与虚弱 rTSAs。比较结果包括活动范围、结果评分以及最近一次随访时的并发症和翻修率:结果:弱aTSAs和弱rTSAs的术后结果分别与正常aTSAs和正常rTSAs相似(P>0.05)。与弱rTSAs相比,弱aTSAs的术后被动(P=0.006)和主动外旋(ER)(P=0.014)效果更好,但术后肩部疼痛和残疾指数(P=0.032)、美国肩肘外科医生(P=0.024)和加州大学洛杉矶分校(P=0.008)评分较差。弱型 aTSAs 在外展(P=0.045 和 P=0.003)和 FE(P=0.011 和 P=0.001)方面达到最小临床重要性差异(MCID)和实质性临床获益的比率较低。弱aTSAs的翻修率较高(P=0.025),但并发症发生率(P=0.291)与弱rTSAs相似:结论:RCI-GHOA和术前FE薄弱的患者在aTSA或rTSA术后获得的结果与术前力量正常的患者相似。术前,弱aTSA与弱rTSA相比,获得了更大的ER,但在临床上,头顶运动的相关改善率较低。证据等级:III级。
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Does preoperative forward elevation weakness affect clinical outcomes in anatomic or reverse total shoulder arthroplasty patients with glenohumeral osteoarthritis and intact rotator cuff?

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).

Methods: A retrospective review of a single institution's prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up.

Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs.

Conclusions: Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs. Level of evidence: III.

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来源期刊
CiteScore
0.30
自引率
0.00%
发文量
55
审稿时长
15 weeks
期刊最新文献
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