reverse overview -姜春岩教授 3_肩关节培训班.pptxVIP

北京⼤学 第四临床医学院 北京积⽔潭医院运动医学中⼼肩关节外科 Chunyan Jiang MD Ph.D Professor, Shoulder Service Beijing Ji Shui Tan Hospital School of Medicine, Peking University • Force imbalance • Superior migration of the humeral head • Deltoid retraction • Non functional joint (unstable center of rotation) Rotator Cuff Deficient Shoulder TSA or HHR – contra-indicated Glenoid loosening First Reversed Prostheses failed because … • Cuff-deficient arthritis: CTA, OA, RA Cuff-deficient fractures very comminuted osteoporotic GT Revisions (failed HHR/TSR, Fx sequelae, infection) Good deltoid Reverse Shoulder Arthroplasty – indications What is proper tension ? feel the conjoined tendon: bow strings ? easiness for dislocation: is it easy ? Feel the deltoid tension: vague ? Cuff-deficient arthritis: CTA, OA, RA Cuff-deficient fractures very comminuted osteoporotic GT Revisions (failed HHR/TSR, Fx sequelae, infection) Good deltoid Reverse Shoulder Arthroplasty – indications Age 70 yrs. ? Reverse for Fractures senior patients pre-existed cuff tears very osteoporotic and comminuted GT locked anterior dislocations • Gallinet D. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res. 2009 Feb;95(1):48-55. level iii • SW Young. Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ J Surg. 2010 Nov;80(11):789-93. level iii • F Sirveau. Reverse prosthesis for acute proximal hymenal fracture: the multicenter study. AAOS Instructional Course Lecture, 2012. level ii • D Cuff. Hemiarthroplasty vs. reverse shoulder arthroplasty for the treatment of comminuted proximal humeral fractures in elderly patients. AAOS ASES-specialty day, 2013. level ii Fx Treatment: Hemi vs Reverse Hemi • All or none • GT healing or cuff function UNPRE