Total Shoulder Replacement

人工全肩關節置換術

徐廣志(Kuang-Chi Hsu)；Edward V. Craig；李土生(Tu-Sheng Lee)

total shoulder arthroplasty ； rotator cuff tear

Journal of Orthopaedic Surgery Taiwan

10卷1期（1993 / 03 / 01）

35 - 45

英文

我們分析了58個Neer II人工全肩關節置換術平均追蹤四年的結果。手術適應症包括骨關節炎，類風濕性關節炎，旋轉肌袖破裂關節病變，外傷後關節炎等。百分之三十三的病人術中接受旋轉肌袖修補，百分之六十的病人接受前肩峰成形術。臨床結果發現百分之八十六的病人在術後得到很好的疼痛解除。肩關節活動範圍及功能術後有顯著改善，而改善之程度則和疾病的本身，旋轉肌袖和三角肌的機能有關。 百分之七十二的病人在淺窩部份可發現x光透射帶(radiolucent line)，百分之九的病人可發現淺窩部份位置改變。百分之四十的病人有肱骨部份向近端位移(proximal migration)的現象，這其中有百分之七十八是漸進性的，顯示了旋轉肌袖功能不良。旋轉肌袖破裂及肩峰成形術和肱骨位移現象有統計上的意義。人工全肩關節置換術可提供非常良好的治療效果，且其合併症的發生很少。前肩峰成形術不能例行的使用在人工肩關節置換術，而機能不全的旋轉肌袖會合併肱骨部份漸進性的向近端位移，是值得注意的問題。

Fifty-eight Neer II total shoulder replacements, performed in 51 patients, were analyzed at a mean follow of four years (2-8 years). The surgical indications included: osteoarthritis, rheumatoid arthritis, cuff tear arthropathy, post-traumatic arthritis, and miscellaneous. Nineteen shoulders had intraoperative rotator cuff repair andanterior acromioplasty was done in thirty-four shoulders. Clinical results indicated 86% excellent pain relief, and 93% satisfactory patient’s overall response. Statistically significant increase in active motion and improved function occurred, the degree of which was related to diagnostic category and competence of the rotator cuff and deltoid. Seventy-two percent of patients had some radiolucent lines around the glenoid component, while nine percent showed an actual change in the glenoid position. Forty percent of all patients showed the position of the humeral component to be superior relative to the glenoid and in 78% of these, appeared to be a progressive superior migration, suggesting rotator cuff incompetence. There was statistically significant relationship between the presence of a rotator cuff tear, the performance of anterior acromio-plasty and the superior migration of the humeral component. However, superior migration of the humeral component was not predictive of a poor clinical result unless it was associated with a change o fthe glenoid position. Primary total shoulder arthroplasty yielded excellent clinical results with low incidence of complications. Routine anterior acromioplasty should not be done in total shoulder replacement. The presence of an incompenent rotator cuff or one that becomes so, is associated with progressive superior migration of the humeral component relative to the glenoid.