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在初级逆向全肩关节整形手术后,肩膀稳定性是否有差异? 一个系统的审查
David Ulery1, Anthony J Mancuso1, Tom Edgerton1
1Mercy Health St. Vincent Medical Center, Department of Orthopedics, Toledo, OH, USA.
JSES reviews, reports, and techniques
|August 17, 2023
概括
反向全肩关节整形手术 (RTSA) 的结果显示,在不稳定性和 subscapularis 修复方面没有显著差异. 植入物设计可能会影响RTSA稳定性,而不是 subscapularis状态,尽管修复可能会改善结果.
科学领域:
- 整形外科手术 整形外科手术
- 生物医学工程 生物医学工程
- 临床研究 临床研究
背景情况:
- 反向全肩关节整形术 (RTSA) 越来越多地用于各种肩部病理,而不仅仅是旋转手套关节炎.
- 手术后的肩部不稳定性是RTSA的重要并发症,报告的发病率范围广泛.
- 造成RTSA不稳定的原因包括假肢设计,手术技术和骨功能.
研究的目的:
- 系统地审查在RTSA后手术后肩部不稳定性的文献.
- 为了比较RTSA与下肌修复和没有下肌修复之间的不稳定率.
- 研究植入物设计对RTSA稳定性的影响.
主要方法:
- 一个PROSPERO注册的系统审查,遵守PRISMA指南.
- 在Cochrane,PubMed,Embase和Eline数据库中进行的搜索.
- 包括7项研究 (III或IV级证据),评估RTSA后手术后的不稳定性.
主要成果:
- 在具有 (0.7%位移) 和没有 (1.5%位移) 下肩骨修复的RTSA之间,在不稳定率上没有发现统计学上显著的差异.
- 植入物设计 (介质化与非侧面化) 显示出与脱位率的显著关联,独立于 subscapularis 修复状态.
- 在 subscapularis 修复后,观察到改善临床结果和运动范围的趋势.
结论:
- 下肌的修复并没有显著改变手术后的肩部不稳定率,主要的RTSA后.
- 植入物设计似乎是RTSA稳定性的更关键因素,而不是 subscapularis 修复.
- 需要进一步的研究来优化RTSA的手术技术和植入物设计,以尽量减少不稳定性和增强功能结果.
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