反式肩关节成形术中肩胛盂基座固定稳定性的研究进展

Research into the fixation stability of the glenoid baseplate in reverse shoulder arthroplasty

反式肩关节成形术(RSA)是20世纪70年代初为了应对肩袖撕裂性肩关节病而提出的。自Grammont医生团队在1985年至1995年间,设计并提出了反式肩关节假体后,RSA手术数量迅速增长,目前其适应证除了肩袖撕裂性肩关节病以外,还包括巨大不可修复性肩袖撕裂、肱骨近端骨折或骨折后遗症、炎症性肩关节病、肩胛盂形态异常引起的骨关节炎、解剖型全肩或半肩置换失败后翻修以及肩部肿瘤。RSA的绝对禁忌证包括感染、完全性腋神经瘫痪、神经性肩关节病以及严重肩胛盂骨侵蚀或缺损。肩胛盂基座的稳定性是影响RSA术后并发症发生率的一个比较重要的因素,而肩胛盂基座的稳定性主要由基座螺钉植入实现。因此,准确地植入合适数量的肩胛盂基座螺钉,对减少RSA手术并发症的发生有重要意义。

Reverse shoulder arthroplasty(RSA)was proposed to deal with rotator cuff tear arthropathy in the 1970s and improved from 1985 to 1995 by Dr.Grammont who designed the contemporary type of reverse shoulder prosthesis successfully.The number of RSAs has grown rapidly over the past decade.Currently,the indications for RSA include,in addition to rotator cuff tear arthropathy,massive rotator cuff tears which can not be repaired,proximal humerus fractures or their sequelae,inflammatory shoulder disease,osteoarthritis with abnormal glenoid morphology,anatomic revision after failed total shoulder arthroplasty or hemiarthroplasty,and shoulder tumors.Absolute contraindications to RSA include infection,complete axillary nerve palsy,neuropathic shoulder arthropathy,and glenoid bone loss.At present,the stability of the glenoid baseplate,an important factor affecting the incidence of postoperative complications,is mainly achieved by implantation of the screws for the glenoid baseplate base.Therefore,correct implantation of the screws is of great significance to reduce the complications in RSA.