摘要目的 研究对比反式全肩关节置换与半肩关节置换术后的临床疗效。方法 分析我院2014年1月至2018年6月收治的行反式全肩关节置换与半肩关节置换的老年患者，回顾性统计分析两种不同术式术后末次随访关节活动度(range of motion，ROM)、视觉模拟评分(visual analogue scale，VAS)、加州大学肩关节评分系统(university of california at losangeles，UCLA)评分、Coleman方法学评分(Coleman methodology score，CMS)以及美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form，ASES)评分。结果 本次实验研究发现，末次随访时反肩关节置换术组ROM：前屈(130.56±3.09)°、外旋(38.44±2.70)°、外展(131.78±2.54)°，半肩关节置换术组ROM：前屈(104.12±7.66)°、外旋(27.06±3.93)°、外展(123.88±4.88)°；反肩关节置换术组前屈、外展及外旋均高于半肩关节置换术组，两组比较差异有统计学意义(P＜0.05)。反肩关节置换术组内旋(41.67±3.39)°，半肩置换术组内旋(48.76±3.29)°；半肩关节置换术组内旋功能优于反肩关节置换术组，两组比较差异有统计学意义(P＜0.05)。反肩关节置换术组术后末次随访UCLA(28.78±2.05)分、CMS(58.89±2.80)分及ASES(74.33±2.18)分，半肩关节置换术后末次随访UCLA(26.24±2.14)分、CMS(56.12±2.47)分及ASES(71.53±2.53)分；两组比较差异具有统计学意义(P＜0.05)，反肩关节置换术组在UCLA、CMS及ASES评分上均优于半肩关节置换术组。反肩关节置换术后末次随访VAS评分为(1.22±0.44)分，半肩关节置换术后末次随访VAS评分为(1.41±0.51)分，两组比较差异无统计学意义(P＞0.05)。结论 术后反式全肩关节置换功能及评分优于半肩关节置换，对于患者生活质量改善有较大帮助，但应严格掌握反式全肩关节置换手术适应证，术前应仔细综合考量。
Abstract：Objective To compare the curative effects of 2 operation methods of reverse shoulder arthroplasty and hemi-shoulder arthroplasty for shoulder joint dysfunction.Methods Data of patients who underwent reverse shoulder arthroplasty and hemi-shoulder arthroplasty from January 2014 to June 2018 in our hospital were collected and followed up respectively.Range of motion(ROM)，Visual Analogue score(VAS)，University of California at LosAngeles score(UCLA)，Adjusted Constant-Murley score(CMS) and American Shoulder and Elbow Surgeons (ASES) of the last follow-up were statistically analyzed.Results In this study，we found ROM of anteflexion，extorsion and abduction in reverse shoulder arthroplasty group were(130.56±3.09)degree，(38.44±2.70)degree and(131.78±2.54)degree respectively at last follow-up，results in hemi-shoulder arthroplasty group were anteflexion (104.12±7.66) degree，extorsion (27.06±3.93)degree and abduction (123.88±4.88)degree，anteflexion，extorsion and abduction were better in reverse shoulder arthroplasty group with P＜0.05.But intorsion degree was(41.67±3.39)degree in reverse shoulder arthroplasty group，with the degree of intorsion (48.76±3.29)degree in hemi-shoulder arthroplasty group，intorsion degree was relatively better in hemi-shoulder arthroplasty group with a significant P value below 0.05.The last follow-ups of UCLA，CMS and ASES in reverse shoulder arthroplasty group were (28.78±2.05)，(58.89±2.80) and (74.33±2.18) correspondingly，and UCLA (26.24±2.14)，CMS(56.12±2.47) and ASES (71.53±2.53) were detected in hemi-shoulder arthroplasty group，UCLA，CMSA and ASES were higher in reverse shoulder arthroplasty group through statistical analyses(P＜0.05).But VAS scores in reverse shoulder arthroplasty group and in hemi-shoulder arthroplasty group were (1.22±0.44) and (1.41±0.51)，which made VAS scores had no difference in comparison，with a pvalue above 0.05.Conclusion Reverse shoulder arthroplasty had relatively better postoperative shoulder function than hemi-shoulder arthroplasty method，it could enhance and improve the quality of patients` life，but this method should hold strict indications and treat it seriously.
王林 1，2，谭杰 2，王皓 1，2，鲁晓波 2*. 反肩置换与半肩置换临床疗效对比研究[J]. 实用骨科杂志, 2019, 25(1): 9-13.
Wang Lin 1，2，Tan Jie 2，Wang Hao 1，2，et al. Comparative Research of the Clinic Efficacy of Reverse Shoulder Arthroplasty and Hemi-shoulder Arthroplasty for Shoulder Disease. sygkzz, 2019, 25(1): 9-13.
［1］Wolff AL，Rosenzweig L.Anatomical and biomechanical framework for shoulder arthroplasty rehabilitation［J］.J Hand Ther，2017，30(2)：167-174.
［2］Lignel A，Berhouet J，Loirat MA，et al.Reverse shoulder arthroplasty for proximal humerus fractures：Is the glenoid implant problematic?［J］.Orthop Traumatol Surg Res，2018，104(6)：773-777.
［3］Grosel TW，Plummer DR，Mayerson JL，et al.Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis［J］.J Surg Oncol，2018，118(6)：867-872.
［4］Leroux TS，Basques BA，Saltzman BM，et al.Shoulder arthroplasty in patients with rheumatoid arthritis：A population-based study examining utilization，adverse events，length of stay，and cost［J］.Am J Orthop (Belle Mead NJ)，2018，47(6)：1-12.
［5］Irlenbusch U，Blatter G，Gebhardt K，et al.Prospective study of double-eccentric hemi shoulder arthroplasty in different aetiologies：midterm results［J］.Int Orthop，2011，35(7)：1015-1023.
［6］Werthel JD，Sirveaux F，Block D.Reverse shoulder arthroplasty in recent proximal humerus fractures［J］.Orthop Traumatol Surg Res，2018，104(6)：779-785.
［7］戈允申，陈世益.肩关节功能评分系统的现状和展望［J］.中华骨科杂志，2007，27(10)：786-789.
［8］戴海峰，李嘉，刘凤，等.反置式全肩关节置换治疗肱骨头坏死近期临床疗效观察［J］.中国矫形外科杂志，2016，24(21)：2000-2003.
［9］Chalmers PN，Salazar DH，Romeo AA，et al.Comparative utilization of reverse and anatomic total shoulder arthroplasty：A comprehensive analysis of a high-volume center［J］.J Am Acad Orthop Surg，2018，26(24)：e504-e510.
［10］陆博，Scarlat MM.反置式肩关节成形术：择期手术的当前趋势［J］.中华骨科杂志，2018，38(10)：627-634.
［11］韩晓珺，戚文潇，方朝毅，等.反置式全肩关节置换术治疗巨大不可修复性肩袖损伤研究进展［J］.国际骨科学杂志，2017，38(6)：341-344.
［12］戴海峰，刘凤，李嘉，等.3 种手术方式治疗老年肱骨近端复杂骨折临床疗效的对比研究［J］.医学研究生学报，2018，31(7)：734-738.
［13］Ascione F，Kilian CM，Laughlin MS，et al.Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem：an analysis of 485 consecutive cases［J］.J Shoulder Elbow Surg，2018，27(12)：2183-2190.
［14］Chae J，Siljander M，Wiater JM.Instability in reverse total shoulder arthroplasty［J］.J Am Acad Orthop Surg，2018，26(17)：587-596.
［15］Werner BS，Chaoui J，Walch G.Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty［J］.Bone Joint J，2018，100(9)：1182-1186.
［16］Ohl X，Bonnevialle N，Gallinet D，et al.How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures［J］.J Shoulder Elbow Surg，2018，27(12)：2139-2144.
［17］Ferrier A，Blasco L，Marcoin A，et al.Geometric modification of the humeral position after total reverse shoulder arthroplasty：what is the optimal lowering of the humerus?［J］.J Shoulder Elbow Surg，2018，27(12)：2207-2213.
［18］Romano AM，Oliva F，Nastrucci G，et al.Reverse shoulder arthroplasty patient personalized rehabilitation protocol.Preliminary results according to prognostic groups［J］.Muscles Ligaments Tendons J，2017，7(2)：263-270.
［19］Uschok S，Herrmann S，Pauly S，et al.Reverse shoulder arthroplasty：the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up［J］.Arch Orthop Trauma Surg，2018，138(12)：1647-1652.
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