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中华肩肘外科电子杂志 ›› 2019, Vol. 07 ›› Issue (03) : 264 -271. doi: 10.3877/cma.j.issn.2095-5790.2019.03.013

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国际肩肘之窗

反置式人工肩关节置换术:并发症成因分析及其对策
吴晓明1, 蔡明2, 东靖明3   
  1. 1. 200086 上海第一人民医院创伤骨科
    2. 200072 上海市第十人民医院骨科
    3. 300000 天津医院骨科
  • 收稿日期:2019-04-18 出版日期:2019-08-05

Complications with reverse total shoulder arthroplasty and recent evolutions

Xiaoming Wu1, Ming Cai2, Jingming Dong3   

  • Received:2019-04-18 Published:2019-08-05
引用本文:

吴晓明, 蔡明, 东靖明. 反置式人工肩关节置换术:并发症成因分析及其对策[J]. 中华肩肘外科电子杂志, 2019, 07(03): 264-271.

Xiaoming Wu, Ming Cai, Jingming Dong. Complications with reverse total shoulder arthroplasty and recent evolutions[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2019, 07(03): 264-271.

图1 法国第戎骨科医生曾尝试设计肩峰型人工肩关节治疗肩袖骨关节病。因为肩袖慢性巨大性撕裂,导致喙肩弓破坏,肱骨头上移,肱骨上端和肩峰呈"杵臼状"改变,即肱骨上端变圆变凸,肩峰端变凹,相互适应彼此的形态的改变,如同股骨头和髋臼样匹配
图2 Grammont型反置式人工肩关节的原型:人工肩关节球形关节面位于肩胛盂侧,肩关节旋转中心内移导致三角肌作用力臂相应的向内侧移动
图3 目前使用的反置式人工肩关节的设计均源于第一代反置式人工肩关节
图4 接受反置式人工肩关节置换术后,肱骨头下缘(HI)和肩胛盂下缘(G)之间的距离增加
图5 利用Delta 2型反置式人工肩关节治疗肱骨近端骨折后遗症时发生了肱骨柄部件之间的解构,注意这类并发症往往发生在右肩,其诱发动作是肩关节的极度内旋
图6 肩袖骨关节病术后 图A:肩胛冈骨折;图B:肩峰骨折,发生在肩关节置换术后3周和8周,患者临床症状轻微
图7 严重的肩胛颈切迹破坏肩胛颈完整性,固定肩胛盂基座螺钉出现断裂,肩胛盂基座松动
图8 肩胛骨切迹形成,肩胛盂基座松动,固定基座螺钉断裂(图A);更换更长的基座螺钉(40 mm)进行翻修(图B)
图9 接受Delta型反置式人工肩关节置换术后,患者肩关节活动范围较术前肩关节假性麻痹有明显改善,虽然其肩关节外旋功能无明显改善,但是患者对手术疗效满意
图10 肩关节正位片难以明确反置式人工肩关节是否存在术后脱位(图A,B);穿胸位片显示肩关节存在后脱位(图C);经复位后,肱骨侧假体位于肩胛盂侧球形关节的前方(图D,E,F)
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