Purpose

This study compared the clinical and radiologic results of reverse shoulder arthroplasty (RSA) using either the subscapularis-sparing deltopectoral approach (SSDA) or traditional deltopectoral approach (TDA) in cuff tear arthropathy patients.

Materials and method

We retrospectively evaluated 71 patients who underwent RSA for cuff tear arthropathy between July 2014 and December 2018. Patients were divided into two groups according to the surgical approach: TDA (34 cases) and SSDA (37 cases). The mean patient age was 78.6 years, and the mean (range) follow-up period was 23.5 (12–48) months. Clinical results were assessed using the Visual Analogue pain Scale (VAS), American Shoulder and Elbow Surgeon score (ASES), Korean Shoulder Scoring System (KSS), and Constant score. Radiographic indicators prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), inferior overhang, acromion-greater tuberosity (AT) distance, and glenoid-greater tuberosity (GT) distance) were assessed, and notching severity was assessed according to the Nerot-Sirveaux classification.

Results

The radiographic indicator results of the TDA and SSDA groups were as follows: PSNA (131.4° ± 17.2°, 136.1° ± 7.7°), PGRD (18.7 mm ± 2.9 mm, 21.4 mm ± 2.0 mm), AT distance (38.3 mm ±6.9 mm, 37.5 mm ± 6.8 mm), GT distance (51.6 mm ± 6.3 mm, 51.4 mm ± 5.3 mm), and inferior overhang (4.4 mm ± 2.2 mm, 2.9 mm ± 1.3 mm). PGRD and inferior overhang showed statistically significant differences between groups, but the clinical results showed no significant differences. There were no complications such as neurovascular injury, implant loosening, surgical site infection, or acromion fracture in either group.

Conclusion

SSDA for RSA showed no significant differences in clinical and radiological results compared with TDA. Therefore, SSDA is a viable alternative for RSA in cuff tear arthropathy.

中文翻译：

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保留肩胛下肌的三角胸肌入路反向全肩关节置换术

目的

本研究比较了使用保留肩胛下肌的三角肌入路 (SSDA) 或传统三角肌入路 (TDA) 对袖带撕裂关节病患者进行反向肩关节置换术 (RSA) 的临床和放射学结果。

材料与方法

我们回顾性评估了 2014 年 7 月至 2018 年 12 月期间接受 RSA 治疗袖带撕裂关节病的 71 例患者。根据手术入路将患者分为两组：TDA（34 例）和 SSDA（37 例）。平均患者年龄为 78.6 岁，平均（范围）随访期为 23.5（12-48）个月。使用视觉模拟疼痛量表 (VAS)、美国肩肘外科医生评分 (ASES)、韩国肩部评分系统 (KSS) 和 Constant 评分评估临床结果。评估了放射学指标假体肩胛颈角 (PSNA)、骨关节盂边缘距离 (PGRD)、下悬垂、肩峰-大结节 (AT) 距离和关节盂-大结节 (GT) 距离），并评估切迹严重程度根据 Nerot-Sirveaux 分类法。

结果

TDA组和SSDA组X线指标结果如下：PSNA（131.4°±17.2°、136.1°±7.7°）、PGRD（18.7 mm±2.9 mm、21.4 mm±2.0 mm）、AT距离（38.3 mm± 6.9 mm、37.5 mm ± 6.8 mm）、GT 距离（51.6 mm ± 6.3 mm、51.4 mm ± 5.3 mm）和劣质悬垂（4.4 mm ± 2.2 mm、2.9 mm ± 1.3 mm）。PGRD 和下悬突在组间显示出统计学上的显着差异，但临床结果显示无显着差异。两组均未出现神经血管损伤、植入物松动、手术部位感染、肩峰骨折等并发症。

结论

与 TDA 相比，SSDA 治疗 RSA 在临床和放射学结果上没有显着差异。因此，在袖带撕裂关节病中，SSDA 是 RSA 的可行替代方案。