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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 338 -342. doi: 10.3877/cma.j.issn.2095-5790.2022.04.008

论著

肩盂内固定术后骨关节炎进展危险因素的回顾分析
游协波1, 吴迪1, 丁振禹1, 余伟林1, 何耀华1,†()   
  1. 1. 200233　上海交通大学医学院附属第六人民医院骨科
  • 收稿日期:2022-09-01 出版日期:2022-11-05
  • 通信作者: 何耀华
  • 基金资助:
    国家自然科学基金(2020-82072401); 国家自然科学基金(2021-82172515)

A retrospective analysis of risk factors for the progression of shoulder osteoarthritis after glenoid labrum surgery

Xiebo You1, Di Wu1, Zhenyu Ding1, Weilin Yu1, Yaohua He1,†()   

  1. 1. Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
  • Received:2022-09-01 Published:2022-11-05
  • Corresponding author: Yaohua He
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游协波, 吴迪, 丁振禹, 余伟林, 何耀华. 肩盂内固定术后骨关节炎进展危险因素的回顾分析[J]. 中华肩肘外科电子杂志, 2022, 10(04): 338-342.

Xiebo You, Di Wu, Zhenyu Ding, Weilin Yu, Yaohua He. A retrospective analysis of risk factors for the progression of shoulder osteoarthritis after glenoid labrum surgery[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(04): 338-342.

目的

分析肩盂内固定手术后盂肱关节骨关节炎进展的危险因素。

方法

本研究回顾性分析了2005年1月至2020年12月本科室接受的肩盂内固定手术患者，包括肩盂骨折内固定及肩盂植骨内固定术。采集患者基线病史、影像学资料、手术资料及术后随访资料，总结其临床特点，分析骨关节炎进展的危险因素。

结果

共纳入58例肩盂内固定手术患者，其中术后骨关节炎进展患者共计11例，多因素Logisitic分析提示高龄（P=0.016）及临界肩角偏小（P=0.002）是肩盂内固定术后发生骨关节炎的独立危险因素。

结论

患者高龄及临界肩角偏小是肩盂内固定术后发生肩关节骨关节炎进展的独立危险因素。

关键词: 肩盂内固定, 骨关节炎, 临界肩角
Background

Glenoid fractures are intra-articular fractures with a low incidence, accounting for only 10%-15% of scapular fractures. However, they often lead to the collapse and displacement of the articular surface, change the shape of the glenohumeral joint, and affect the function of the shoulder joint. Due to the joint involvement of such fractures, surgical treatment is often used to restore the patient's shoulder joint function to the maximum extent. Although the long-term efficacy of surgical treatment is good, there are still a series of complications, including nonunion, infection, joint stiffness, and osteoarthritis. Glenohumeral joint osteoarthritis is one of the most severe long-term complications after glenoid internal fixation surgery, manifested as shoulder joint pain and limited mobility. Clinically, many patients who have undergone internal fixation of glenoid fractures or internal fixation of glenoid bone grafts, even with sound reduction and internal fixation, will still have osteoarthritis changes in the shoulder joint in the long term, which seriously affects the prognosis of patients, reduces the quality of life and exercise level.

Objective

To analyze the risk factors for the progression of glenohumeral osteoarthritis in patients undergoing glenoid labrum internal fixation surgery.

Methods

This study retrospectively reviewed patients who underwent glenoid fixation in our department from January 2005 to December 2020, including glenoid fracture internal fixation and glenoid bone defect fixing using a bone graft. Baseline medical history, imaging, surgical, and postoperative follow-up data were collected to summarize the clinical characteristics and analyze the risk factors of osteoarthritis progression.

Results

Overall, 58 patients were included in this study, including 11 patients with osteoarthritis progression after internal glenoid fixation. Multivariate logistic regression analysis suggested that advanced age (P= 0.016) and slight critical shoulder angle (P= 0.002) were independent risk factors for osteoarthritis progression after glenoid internal fixation.

Conclusion

Advanced age and slight critical shoulder angle are independent risk factors for the progression of shoulder osteoarthritis after surgery.

Key words: Glenoid labrum, Shoulder osteoarthritis, Critical shoulder angle
图1 典型病例：患者1，34岁男性，肩盂骨折术前X线片（图A）及切开复位内固定术后X线片（图B）；患者2，38岁男性，肩关节复发性脱位肩盂骨缺损术前X线片（图C）及肩关节镜下肩盂植骨内固定术后X线片（图D）
图2 肩胛盂骨性参数的影像学测量　图A：CSA为肩胛盂上下缘连线与肩胛盂下缘和肩峰外侧缘连线所形成的锐性夹角（α）；图B：AI为肩峰外侧缘至肩胛盂上下缘连线的垂直距离与肱骨头最外侧缘到肩胛盂上下缘连线垂直距离之间的比值；图C：LAA为肩峰底面内外侧缘连线与肩胛盂上下缘连线形成的外下象限夹角（γ）；图D：肩盂倾向是计算冈上窝底部直线与肩胛盂上下缘连线外下夹角（β）的余角（90°-β），若正则为上倾，负则为下倾，图中病例为上倾注：CSA为临界肩角；AI为肩峰指数；LAA为肩峰外延角
表1 肩盂内固定术后患者基线资料及临床资料分析
组别 例数 性别（男/女） 年龄（岁，±s） BMI （±s） 手术侧（右/左） 手术方式（肩关节镜下修补+植骨内固定术/肩盂骨折切开复位内固定术） 手术间隔时间（月，±s） CSA （±s） AI （±s） 肩胛盂倾向（下倾/上倾） LAA （±s）
对照组 47 37/10 40.5±14.2 25.9±2.9 35/12 30/17 0.62±0.56 41.01±5.19 0.82±0.81 9/38 68.11±7.50
骨关节炎组 11 6/5 52.1±14.9 25.7±2.9 7/4 5/6 0.40±0.32 34.63±5.03 0.80±0.09 1/10 69.24±9.42
检验值   x2=2.718 t=2.340 t=0.201 x2=0.524 x2=1.258 t=1.753 t=3.691 t=0.767 x2=0.632 t=0.428
P值   0.131 0.034 0.841 0.475 0.316 0.091 0.001 0.446 0.669 0.671
表2 肩盂内固定术后骨关节炎进展的单因素和多因素Logistic回归分析
因素 单因素Logistic 多因素Logistic
OR 95% CI P值 OR 95% CI P值
性别 3.083 0.778-12.221 0.109      
年龄 1.056 1.006-1.108 0.027 1.085 1.015-1.159 0.016
BMI 0.976 0.773-1.233 0.838      
手术侧 0.600 0.149-2.415 0.472      
手术方式 2.118 0.561-7.988 0.268      
手术间隔时间 0.348 0.064-1.890 0.221      
CSA 0.779 0.660-0.919 0.003 0.744 0.617-0.898 0.002
AI 0.046 0.001-113.395 0.440      
肩胛盂倾向 2.368 0.268-20.957 0.438      
LAA 1.019 0.937-1.108 0.665      
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