AIM To evaluate the joint geometry and the clinical outcome of stemless,anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included.On scaled dig...AIM To evaluate the joint geometry and the clinical outcome of stemless,anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included.On scaled digital radiographs the premorbid center of rotation(CoR)was assessed and compared to the CoR of the prosthesis by using the MediC AD~?software.Additionally,the pre-and post-operative geometry of the CoR was assessed in relation to the glenoid,the acromion as well as to the proximal humerus.Radiological changes,such as radiolucencies,were also assessed.Clinical outcome was assessed with the Constant and DASH score.RESULTS Both,the Constant and DASH scores improved signifi-cantly from 11%to 75%and from 70 to 30 points,P<0.01 respectively.There were no significant differences regarding age,etiology,cemented or metal-backed glenoids,etc.(P>0.05).The pre-and postoperative humeral offset,the lateral glenohumeral offset,the height of the CoR,the acromiohumeral distance as well as neckshaft angle showed no significant changes(P>0.05).The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0±2.8 mm.Three cases showed a medial deviation of more than 3 mm.These deviations of 5.1,5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut.These 3 patients showed a relatively poor outcome scoring.CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome.Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.展开更多
通过对比传统有柄股骨假体的应力分布来研究新型无柄股骨假体的生物力学性能.利用真实人体股骨上端的CT扫描图像,建立完整股骨、2个或3个固定螺钉的无柄假体、传统有柄假体的三维有限元模型.模拟人单腿直立的载荷情况,分析和比较每种模...通过对比传统有柄股骨假体的应力分布来研究新型无柄股骨假体的生物力学性能.利用真实人体股骨上端的CT扫描图像,建立完整股骨、2个或3个固定螺钉的无柄假体、传统有柄假体的三维有限元模型.模拟人单腿直立的载荷情况,分析和比较每种模型的V on M ises应力分布.研究表明,无柄假体股骨上的V on M ises应力比传统有柄假体和完整股骨上的都要高;与传统有柄假体相比,防止了应力遮挡效应的产生;2个或3个固定螺钉的无柄假体在股骨的V on M ises应力分布上没有明显差别.新型无柄假体可以防止应力遮挡效应,和传统有柄假体相比能够使股骨上的应力分布更加符合实际的生理情况.展开更多
背景:全肩关节置换治疗肩骨关节炎的临床疗效是显著的,一些对照研究尝试回答无柄假体与有柄假体治疗肩骨关节炎临床疗效的优劣,但得出的结论有待进一步证实。目的:系统评价在全肩关节置换中应用无柄假体与有柄假体治疗肩骨关节炎的临床...背景:全肩关节置换治疗肩骨关节炎的临床疗效是显著的,一些对照研究尝试回答无柄假体与有柄假体治疗肩骨关节炎临床疗效的优劣,但得出的结论有待进一步证实。目的:系统评价在全肩关节置换中应用无柄假体与有柄假体治疗肩骨关节炎的临床疗效。方法:计算机检索(建库至2018年9月)Pub Med、SpringerLink、Web of Science、EBSCO、The Cochrane Library、EMBASE、CNKI、WANFANG Data、VIP数据库,收集关于无柄假体与有柄假体全肩关节置换治疗肩骨关节炎的随机对照研究和非随机对照研究。对文献进行方法学质量评价。采用Cochrane协作网提供的Rev Man 5.3软件进行Meta分析,比较无柄假体与有柄假体治疗肩骨关节炎的临床疗效。结果与结论:(1)共纳入5篇研究,其中3篇随机对照研究,2篇非随机临床对照研究,共计182例患者190肩(此文按肩计数分析);(2)Meta分析结果显示,无柄假体组较有柄假体组的手术时间短,术后估计失血量少;(3)无柄假体组术后Constant肩关节评分较有柄假体组更低,行敏感性分析,剔除1篇低质量文献后,2组术后Constant肩关节评分的差异无显著性意义;(4)2组术后日常生活活动能力评分、力量评分、疼痛评分、肩膀运动范围评分以及肩关节前屈度、外展度的差异均无显著性意义;(5)提示无柄假体与有柄假体全肩关节置换治疗肩骨关节炎的术后短中期疗效相当;但从理论上认为,无柄假体全肩关节置换在治疗肩骨关节炎方面存在更大的优势,能缩短手术时间,降低术后失血量。展开更多
文摘AIM To evaluate the joint geometry and the clinical outcome of stemless,anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included.On scaled digital radiographs the premorbid center of rotation(CoR)was assessed and compared to the CoR of the prosthesis by using the MediC AD~?software.Additionally,the pre-and post-operative geometry of the CoR was assessed in relation to the glenoid,the acromion as well as to the proximal humerus.Radiological changes,such as radiolucencies,were also assessed.Clinical outcome was assessed with the Constant and DASH score.RESULTS Both,the Constant and DASH scores improved signifi-cantly from 11%to 75%and from 70 to 30 points,P<0.01 respectively.There were no significant differences regarding age,etiology,cemented or metal-backed glenoids,etc.(P>0.05).The pre-and postoperative humeral offset,the lateral glenohumeral offset,the height of the CoR,the acromiohumeral distance as well as neckshaft angle showed no significant changes(P>0.05).The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0±2.8 mm.Three cases showed a medial deviation of more than 3 mm.These deviations of 5.1,5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut.These 3 patients showed a relatively poor outcome scoring.CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome.Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.
文摘通过对比传统有柄股骨假体的应力分布来研究新型无柄股骨假体的生物力学性能.利用真实人体股骨上端的CT扫描图像,建立完整股骨、2个或3个固定螺钉的无柄假体、传统有柄假体的三维有限元模型.模拟人单腿直立的载荷情况,分析和比较每种模型的V on M ises应力分布.研究表明,无柄假体股骨上的V on M ises应力比传统有柄假体和完整股骨上的都要高;与传统有柄假体相比,防止了应力遮挡效应的产生;2个或3个固定螺钉的无柄假体在股骨的V on M ises应力分布上没有明显差别.新型无柄假体可以防止应力遮挡效应,和传统有柄假体相比能够使股骨上的应力分布更加符合实际的生理情况.
文摘背景:全肩关节置换治疗肩骨关节炎的临床疗效是显著的,一些对照研究尝试回答无柄假体与有柄假体治疗肩骨关节炎临床疗效的优劣,但得出的结论有待进一步证实。目的:系统评价在全肩关节置换中应用无柄假体与有柄假体治疗肩骨关节炎的临床疗效。方法:计算机检索(建库至2018年9月)Pub Med、SpringerLink、Web of Science、EBSCO、The Cochrane Library、EMBASE、CNKI、WANFANG Data、VIP数据库,收集关于无柄假体与有柄假体全肩关节置换治疗肩骨关节炎的随机对照研究和非随机对照研究。对文献进行方法学质量评价。采用Cochrane协作网提供的Rev Man 5.3软件进行Meta分析,比较无柄假体与有柄假体治疗肩骨关节炎的临床疗效。结果与结论:(1)共纳入5篇研究,其中3篇随机对照研究,2篇非随机临床对照研究,共计182例患者190肩(此文按肩计数分析);(2)Meta分析结果显示,无柄假体组较有柄假体组的手术时间短,术后估计失血量少;(3)无柄假体组术后Constant肩关节评分较有柄假体组更低,行敏感性分析,剔除1篇低质量文献后,2组术后Constant肩关节评分的差异无显著性意义;(4)2组术后日常生活活动能力评分、力量评分、疼痛评分、肩膀运动范围评分以及肩关节前屈度、外展度的差异均无显著性意义;(5)提示无柄假体与有柄假体全肩关节置换治疗肩骨关节炎的术后短中期疗效相当;但从理论上认为,无柄假体全肩关节置换在治疗肩骨关节炎方面存在更大的优势,能缩短手术时间,降低术后失血量。
