UNIVERS 3-D肩关节假体置换治疗类风湿性肩关节炎

Clinical results of shoulder arthroplasty with the UNIVERS 3-D prosthesis in rheumatoid arthritis

目的 评测UNIVERS 3 D肩关节假体置换治疗类风湿性肩关节炎的临床效果。方法 6例类风湿性肩关节炎接受了UNIVERS 3 D假体半肩关节置换治疗 ,5例获得至少 12个月的临床随访 ,最长 45个月 ,平均随访 2 6个月。功能评估采用Constant评分和Constant修正评分标准 ;X线片随访包括 :前后位、轴位和“Y”型位X线片。根据Levigne的两种不同方法进行分级。结果 术后Constant评分和修正评分除 1例术后功能提高不明显外 ,其余病人均得到了至少 2倍以上的功能改善。未发现X线透亮带和假体松动 ,无肱骨假体头 颈连接部的松动和脱位。术后 1例并发症 ,为盂肱关节前上半脱位 ,没有对病人进行任何外科处理。根据肱骨头球状面形态和肱骨头相对于关节盂向上漂移的情况 :4例破坏型 ,1例中心型 ,1例向上型 ;肱骨头磨损 :微线型 2例 ,大结节凹槽型 1例 ,肱骨头球形变形 3例。不同的影像分级其临床结果不同。结论 UNIVERS 3 D假体肩关节置换治疗类风湿性肩关节炎临床效果非常满意 ;无X线透亮带发生 ,术后并发症低。类风湿性肩关节炎的影像学分级可能有助于手术的选择及推断其预后。

Objective To evaluate the clinical results of arthroplasty with the UNIVERS 3 D prosthesis in shoulder rheumatoid arthritis (RA). Methods Six cases of shoulder RA underwent the arthroplasty with the UNIVERS 3 D prosthesis. Five cases were strictly reviewed by Constant score and normalized Constant score after operation with an average follow up of 26 months, ranging from 12 to 45 months. Five cases were reviewed by the radiological analysis on preoperative and postoperative X ray including three AP views, scapular view, and axillary view. The radiographic forms were classified by two different criteria according to Levigne. Results The postoperative Constant score (mean, 55.06) and normalized Constant score (mean, 72.2%) were improved more than one time in all cases except one. Complication of anterior superior subluxation occurred in glenohumeral joint of one case and no surgical treatment performed. The radiographic forms were classified by Levigne on humeral head wear (including 2 cases of microgeodes, 1 case for notch in the greater tuberosity, and 3 cases for spherical form loss) and on the sphericity and upward migration of the humeral head (1 case for ascending form, 1 case for centered form, and 4 cases for destructive form) according to the clinical results. Conclusion The arthroplasty with the UNIVERS 3 D prosthesis results with excellent clinical function results in shoulder RA without any radiolucent line and with very low complication. Radiological classification on the sphericity and upward migration of the humeral head, and humeral head wear may be useful element in operation choice and its prognosis.