重视反式肩关节置换治疗巨大肩袖撕裂骨关节病的关键技术与风险因素

Reverse total shoulder arthroplasty for cuff tear arthropathy:key techniques and risk factors

巨大肩袖撕裂骨关节病的特点为巨大肩袖撕裂以及继发的盂肱关节退变,肩关节的动态和静态稳定结构受到破坏,同时伴有严重的骨性畸形,治疗效果欠佳,一直是临床中的治疗难题。反式肩关节置换的出现为此类患者提供了良好的解决方案,成为重要的治疗手段。反式肩关节置换治疗巨大肩袖撕裂骨关节病患者时,存在诸多影响治疗效果的风险因素,包括机械性撞击、肩盂骨缺损以及软组织张力失衡等。面对上述风险因素,选择适合的关键技术对预后至关重要。偏心性锉磨技术适用于合并轻度肩盂骨缺损、潜在机械性撞击风险的患者。对于重度肩盂骨缺损的患者,肩盂植骨或个体化假体置换是有效的治疗手段。对外旋受限、小圆肌脂肪浸润严重的患者需要联合肌腱转位技术。为了平衡软组织张力可通过改变聚乙烯衬垫厚度或者盂球假体直径来实现。

Cuff tear arthropathy(CTA)is characterized by massive rotator cuff tear and secondary glenohumeral degeneration,the dynamic and static stability of the shoulder joint is damaged,accompanied by serious bone deformities,and the treatment effect is poor,which has been a difficult problem in clinical treatment.Successful surgical management of CTA poses a considerable challenge,and reverse shoulder arthroplasty(RSA)is the first choice to improve outcome in CTA patients.However,the success of RSA can be compromised by several risk factors,including mechanical impingement,glenoid bone defects,and imbalances in soft tissue tension.Addressing these risk factors with appropriate techniques is crucial for outcomes.The eccentric reaming technique is suitable for patients with mild glenoid bone defects and potential risk of mechanical impingement.For patients with severe glenoid bone defects,glenoid bone grafting and individualized prosthesis replacement are effective treatment strategies.For patients with limited external rotation and severe fatty infiltration of the teres minor,tendon transfer is necessary.To balance soft tissue tension,various interventions can be employed,such as altering the thickness of polyethylene liners or changing the diameter of the glenoid prosthesis.