反肩置换与半肩置换临床疗效对比研究

Comparative Research of the Clinic Efficacy of Reverse Shoulder Arthroplasty and Hemi-shoulder Arthroplasty for Shoulder Disease

目的研究对比反式全肩关节置换与半肩关节置换术后的临床疗效。方法分析我院2014年1月至2018年6月收治的行反式全肩关节置换与半肩关节置换的老年患者,回顾性统计分析两种不同术式术后末次随访关节活动度(range of motion,ROM)、视觉模拟评分(visual analogue scale,VAS)、加州大学肩关节评分系统(university of california at losangeles,UCLA)评分、Coleman方法学评分(Coleman methodology score,CMS)以及美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form,ASES)评分。结果本次实验研究发现,末次随访时反肩关节置换术组ROM:前屈(130.56±3.09)°、外旋(38.44±2.70)°、外展(131.78±2.54)°,半肩关节置换术组ROM:前屈(104.12±7.66)°、外旋(27.06±3.93)°、外展(123.88±4.88)°;反肩关节置换术组前屈、外展及外旋均高于半肩关节置换术组,两组比较差异有统计学意义(P<0.05)。反肩关节置换术组内旋(41.67±3.39)°,半肩置换术组内旋(48.76±3.29)°;半肩关节置换术组内旋功能优于反肩关节置换术组,两组比较差异有统计学意义(P<0.05)。反肩关节置换术组术后末次随访UCLA(28.78±2.05)分、CMS(58.89±2.80)分及ASES(74.33±2.18)分,半肩关节置换术后末次随访UCLA(26.24±2.14)分、CMS(56.12±2.47)分及ASES(71.53±2.53)分;两组比较差异具有统计学意义(P<0.05),反肩关节置换术组在UCLA、CMS及ASES评分上均优于半肩关节置换术组。反肩关节置换术后末次随访VAS评分为(1.22±0.44)分,半肩关节置换术后末次随访VAS评分为(1.41±0.51)分,两组比较差异无统计学意义(P>0.05)。结论术后反式全肩关节置换功能及评分优于半肩关节置换,对于患者生活质量改善有较大帮助,但应严格掌握反式全肩关节置换手术适应证,术前应仔细综合考量。

Objective To compare the curative effects of 2 operation methods of reverse shoulder arthroplasty and hemi-shoulder arthroplasty for shoulder joint dysfunction.Methods Data of patients who underwent reverse shoulder arthroplasty and hemi-shoulder arthroplasty from January 2014 to June 2018 in our hospital were collected and followed up respectively.Range of motion(ROM),Visual Analogue score(VAS),University of California at LosAngeles score(UCLA),Adjusted Constant-Murley score(CMS)and American Shoulder and Elbow Surgeons(ASES)of the last follow-up were statistically analyzed.Results In this study,we found ROM of anteflexion,extorsion and abduction in reverse shoulder arthroplasty group were(130.56±3.09)degree,(38.44±2.70)degree and(131.78±2.54)degree respectively at last follow-up,results in hemi-shoulder arthroplasty group were anteflexion(104.12±7.66)degree,extorsion(27.06±3.93)degree and abduction(123.88±4.88)degree,anteflexion,extorsion and abduction were better in reverse shoulder arthroplasty group with P<0.05.But intorsion degree was(41.67±3.39)degree in reverse shoulder arthroplasty group,with the degree of intorsion(48.76±3.29)degree in hemi-shoulder arthroplasty group,intorsion degree was relatively better in hemi-shoulder arthroplasty group with a significant P value below 0.05.The last follow-ups of UCLA,CMS and ASES in reverse shoulder arthroplasty group were(28.78±2.05),(58.89±2.80)and(74.33±2.18)correspondingly,and UCLA(26.24±2.14),CMS(56.12±2.47)and ASES(71.53±2.53)were detected in hemi-shoulder arthroplasty group,UCLA,CMSA and ASES were higher in reverse shoulder arthroplasty group through statistical analyses(P<0.05).But VAS scores in reverse shoulder arthroplasty group and in hemi-shoulder arthroplasty group were(1.22±0.44)and(1.41±0.51),which made VAS scores had no difference in comparison,with a pvalue above 0.05.Conclusion Reverse shoulder arthroplasty had relatively better postoperative shoulder function than hemi-shoulder arthroplasty method,it could enhance and improve the quality of patientslife,but this method should hold strict indications and treat it seriously.