Journal of shoulder and elbow surgery · 2018
Lateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Lowe Jeremiah T, Lawler Sarah M, Testa Edward J, Jawa Andrew
Аннотация
HYPOTHESIS: Grammont-style reverse shoulder arthroplasty (RSA) has an increased risk of nerve injury compared with anatomic total shoulder arthroplasty (TSA) due to arm lengthening. We hypothesized that an RSA with a lateralized glenosphere and 135° neck-shaft angle would reduce humeral lengthening and decrease the risk of nerve injury to the level of a TSA.
METHODS: The study prospectively enrolled 50 consecutive patients undergoing RSA (n = 30) or TSA (n = 20) as determined by a power analysis based on previous research for our institution. Intraoperative neuromonitoring was used to detect nerve alerts during 4 distinct stages of the procedure. Preoperative and postoperative arm lengths were measured on scaled radiographs. Patients were examined immediately postoperatively and at follow-up visits for neurologic complications.
RESULTS: Mean motor and sensory nerve alerts per case were similar for TSA and RSA (motor: TSA, 1.5 ± 2; RSA, 1.5 ± 2; P = .96; sensory: TSA, 0.6 ± 0.9; RSA, 0.2 ± 0.6; P = .06). The mean change in arm length was 3 ± 7 mm in the TSA cohort vs. 14 ± 7 mm in the RSA cohort (P = .0001). Temporary neurologic changes postoperatively were noted in 1 TSA and 1 RSA patient, amounting to a 4% incidence of nerve injury.
CONCLUSIONS: An RSA design with a lateralized glenosphere and a lower neck-shaft angle decreases arm lengthening compared with the Grammont design. The reduction in lengthening appears to eliminate the historically increased risk of neurologic injury associated with RSA relative to TSA.
METHODS: The study prospectively enrolled 50 consecutive patients undergoing RSA (n = 30) or TSA (n = 20) as determined by a power analysis based on previous research for our institution. Intraoperative neuromonitoring was used to detect nerve alerts during 4 distinct stages of the procedure. Preoperative and postoperative arm lengths were measured on scaled radiographs. Patients were examined immediately postoperatively and at follow-up visits for neurologic complications.
RESULTS: Mean motor and sensory nerve alerts per case were similar for TSA and RSA (motor: TSA, 1.5 ± 2; RSA, 1.5 ± 2; P = .96; sensory: TSA, 0.6 ± 0.9; RSA, 0.2 ± 0.6; P = .06). The mean change in arm length was 3 ± 7 mm in the TSA cohort vs. 14 ± 7 mm in the RSA cohort (P = .0001). Temporary neurologic changes postoperatively were noted in 1 TSA and 1 RSA patient, amounting to a 4% incidence of nerve injury.
CONCLUSIONS: An RSA design with a lateralized glenosphere and a lower neck-shaft angle decreases arm lengthening compared with the Grammont design. The reduction in lengthening appears to eliminate the historically increased risk of neurologic injury associated with RSA relative to TSA.