Like the hip, the shoulder includes a ball and socket articulation. The replacing of the shoulder articulation is the operation which occupies the 3rd topographic point among common joint replacing, merely after replacing of the hip and articulatio genus articulations. Historically, shoulder replacing has a clear and defined objective which to reconstruct or retroflex the bone of the glenohumeral and the rotator turnup. The nature of shoulder arthroplasty is the most complex articulation Reconstruction in the human organic structure. It need see the factors of figure and fluctuation. With the development of surgical techniques and clinical doctors recognize, shoulder joint anatomy engineering has made important advancement. With the development of surgical techniques and clinical doctors recognize, shoulder joint anatomy engineering has made appreciable advancement. The modem epoch of shoulder replacing is no more than thirty old ages old range to present society. The conventional entire shoulder arthroplasty ( TSA ) achieves this end that it brings significantly improves map for many patients and reduces pain they suffer.
The cost of wellness attention is increasing every twelvemonth. There is a turning demand that the costs of intervention be justified by proved measuring of quality of life betterment. In finding the appropriate use for joint replacing surgery, and therefore specifying its function in the intervention of degenerative upsets, effectiveness rating is critical. Regional fluctuations in the frequence of joint replacing processs and the deficiency of consensus sing many facets of related patient attention, which have spurred involvement in the methodological analysis of surgical results research. The purpose is to better specify the function of specific interventions through valid, evidence-based clinical result and epidemiological surveies.
1 The development of the shoulder arthroplasty
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The history of shoulder replacing can be dated from late nineteenth century France. A Parisian tooth doctor, J. Michael Porter, who designed pean unreal shoulder which successful dainty a patient whose shoulder was already tubercular infection. This operate can be classified as an original implant in the country of glenoid part. ( Lugli, 1978 ) In 1953, the Neer produced vanadium unreal humeral caput prosthetic device to handle humerus near terminal comminuted break and the consequence achieved satisfactory healing consequence. From now shoulder arthroplasty began to be widely used in clinical intervention. The technique advanced highly rapidly in following few old ages. Since half shoulder arthroplasty ( besides called unreal humeral caput prosthetic device replacing, hemi-arthroplasty, HA ) successful treated humeral breaks near terminal, this technique applied the range of the shoulder joint replacing bit by bit spread to osteoarthritis, rheumatoid arthritis. This operation does non handle the shoulder articulation disease that the both sides of the articulate surface caput of the humerus and glenoid pit have been broken. In 1970s, Neer added polythene glenoid pit prosthetic device on the unreal humeral caput prosthetic device, in order to develop the first coevals which is Neera… entire shoulder prosthetic device system. Because the glenoid pit prosthetic device can easy be abraded, loosed and shoulder joint replacing inspection and repair engineering non mature, clinical applications tend to utilize HA, but there are besides glenoid pit abrasion job. Biological surface angioplasty began to clinical applications in 1988, ( Krishnan SG, 2007 ) in order to supply a method to work out glenoid pit bring by the wear job of the humeral HA prosthetic device. At the same clip, other types of the shoulder joint replacing engineering besides begins to look and use, such as unreal humeral caput prosthetic device surface replacing, shoulder arthroplasty somersault angioplasty, and so on. At present shoulder arthroplasty has become a preferable method to handle most patients suffer from diseases of end-stage shoulder arthritis and humerus near terminal comminuted break. The current research chiefly focused on the humeral caput prosthetic device and glenoid pit prosthetic design, in order to cut down glenoid pit wear.
2 the caput of the humerus prosthetic device replacing position
Shoulder joint prosthetic device design for the chief portion of the caput of the humerus. The survey found that the curvature radius of the caput of the humerus was inconsistent, in each subdivision on the consecutive size is non the same. Now the caput of the humerus prosthetic device design is the caput of the humerus diameter and thickness correlativity coefficient as 0.75 ( Gregory T, 2007 ) The size of the caput of false organic structure and the shoulder articulation stabilisation straight relate to the strength of environing musculus in shoulder arthroplasty. Not suited prosthetic device caput will impact the caput of the humerus normal centre of rotary motion, change the shoulder articulation lever arm about, so that the musculus map alteration, causes a shoulder to shoulder, environing soft tissue hurt replacing failure. So first of all should take appropriate false figure figure to reconstruct the humerus near terminal anatomy, so as Reconstruction of soft tissue around the balance ( Yuan benxiang, 2005 ) .
Normal shoulder the caput of the humerus and glenoid pit are non fiting, glenoid pit surface curvature radius is bigger than the curvature radius of caput of the humerus 2 ~ 3 millimeter, and the being of articular gristle and dishes lip in do them both basic matching. Shoulder arthroplasty `` mismatch '' refers to curvature radius of the caput of the humerus prosthetic device and glenoid pit prosthetic device are different, the ratio between them called consistent index, research shows that when the index is 0.80 ~ 0.88, joint stableness is best ( Anglin C, 2001 ) . It is considered that it will be better if the glenoid pit and the caput of the humerus prosthetic device in shoulder arthroplasty are wholly fiting from some theories, but in pattern most bookmans believe that do non fit more contributing to the stableness of the shoulder. The ground include two chief point: one is that does non fit the design can be in prosthetic device disruption happened when half the extra burden transportation to the environing soft tissue, cut down direct action in the articulations of dishes from head burden from head burden is the consequence of joint prosthetic device relaxation after one of the chief grounds. The 2nd point is that the comparatively little caput of the humerus false physical lessening abrasion atom coevals.
The design and choice of caput of the humerus prosthetic device depends on the length and the mush pit breadth. Medullary pit breadth and humeral diameter relate to the thickness of the cerebral mantle, seemingly show approximately broad at the top and narrow in the underside. When intraoperative to the full enlarge mush aid prosthetic device grip with the environing bone, and to recognize the full contact force per unit area distribution better, better prosthetic device handle stableness.
At present, although the 3rd coevals of anatomical type prosthetic device system already can good better the forecast of patients. Through the betterment of the caput of the humerus prosthetic device, prosthetic device single adaptability increased, shoulder map and the quality of life improved.
2.2 the caput of the humerus prosthetic device fixed engineering
The caput of the humerus prosthetic device grip fixed means has bone cement and the bone cement two. Bone cement into the bone cement and close terminal bone cement fixed engineering, non-bone cement is divided into force per unit area with fixed and compression bone grafting.
3 glenoid pit prosthetic device replacing position
Glenoid pit prosthetic device has been use as clinical applications for 30 old ages, but it is still controversial. In the shoulder arthroplasty after usage joint prosthetic device will non merely increase the operation clip, intraoperative sum of hemorrhage and operation trouble, and a series of postoperative complications may happen, particularly glenoid pit prosthetic device relaxation. Glenoid pit prosthetic device relaxation is the consequence of operation failure, demand to make shoulder joint replacing surgery is one of the chief grounds for the alteration.
3.1 glenoid pit the applied anatomy and prosthetic device design
Glenoid pit prosthetic device ideal design is to recognize anatomical Reconstruction, glenoid pit the applied anatomy and biomechanics belongings of the prosthetic device design has an of import function. At present there are chiefly the undermentioned difference: ( 1 ) the glenoid pit prosthetic stuff: all sorts of polyethylene prosthetic device and metal pat of polyethylene prosthetic device. ( 2 ) The form of the glenoid pit, Due to the glenoid pit bone mass less, addition with age will do bone loss, and patterned advance of disease cause bone defect, and glenoid pit signifier will be altered evidently, increase the trouble of the anatomical Reconstruction. In order to recognize the anatomical Reconstruction, bookmans design the ultra-high molecular weight polythene cuneus gasket to counterbalance for defect, preoperative adopts modern imaging engineering after bone and joint harm, right rating, in order to run into the single intervention. Glenoid pit prosthetic device nidation manner: joint prosthetic device after implant place to action in bone cement bed emphasis and glenoid pit prosthetic device have obvious influence on the burden, prosthetic Angle can besides impact the caput of the humerus in glenoid pit prosthetic device place [ 16 ] . The survey found that the glenoid pit and shoulder blade organic structure between axis Angle, Angle in the forward 2 A° and pour 7 A° between, after an norm of 1.23 A° pour, glenoid pit prosthetic device downward inclining a hitter to cut down the caput of the humerus prosthetic displacement, so glenoid pit prosthetic device nidation in moderate backward, downward inclining can break cut down partial head burden, and false organic structure wear and loose ( Yuan benxiang, 2005 )
3.2 glenoid pit prosthetic device fixed engineering
Glenoid pit prosthetic fixed engineering harmonizing to the fixed manner into bone cement and the bone cement, harmonizing to the prosthetic device design patterns into bolt fixed and stagger fixed. At present most bookmans think bone cement is non bone cement fixed more stable house.
Neer design application foremost glenoid pit prosthetic device is made from polyethylene stuffs, ellipse, curved back, the bone cement and stagger fixed, after 30 old ages of survey the proficient betterment is really little. Pure polythene, bone cement fixed, arc line drive prosthetic device design still is the best pick, the difference is bolt fixed than stagger fixed more stable.
4 other technological advancement
4.1 glenoid pit biological surface angioplasty
In the presence of glenoid pit prosthetic device relaxation and pure HA the glenoid pit wear, glenoid pit biological surface angioplasty began to clinical applications. It is in the footing of HA will joint capsule, wide facia, Achilles tendon or semilunar cartilage and organ transplant fixed on glenoid pit, and `` file dishes and activities to reshape '' engineering.
The angioplasty is chiefly used in immature and middle-aged patients, but compared with the TSA its healing consequence is unsure. Krishnan reported the shoulder arthritis utilizing glenoid pit biological surface angioplasty intervention after five old ages, it was found that glenoid pit of wear and tear visible radiation, the caput of the humerus prosthetic device stableness, did non happen secondary to false organic structure wear and the dishes brachial arthritis, shoulder articulation map is good. They think the glenoid pit biological surface angioplasty can obtain and TSA similar clinical results. The operation that immature patients and to shoulder joint map demanding patients has a opportunity to go through a comparatively long recuperation achieve good shoulder articulation map recovery, and to avoid a joint prosthetic device nidation after the hazards of, but still necessitate farther measure its effectivity and persistent. By utilizing this engineering is still need to be solved such as transplant stuff beginning, its lastingness, surgical hurt jobs such as large. The development of tissue technology make it go the solution of this job is one of the most effectual ways.
4.2 shoulder joint replacing alteration processs
Shoulder arthroplasty can look for shoulder hurting worse and functional restrictions, need to shoulder joint replacing alteration processs. Neer will be its ground loosely grouped into the undermentioned three facets: [ 2 ] : ( 1 ) the hapless preoperative status, such as rotator turnup hurt, infection, etc. ; ( 2 ) the operation and the false organic structure of complications, such as during the operation, the structural harm, anatomical Reconstruction failure ; ( 3 ) the jobs, such as rehabilitation exercising, hapless dishes brachial joint continued instability. HA postoperative lead to pass the most common ground is glenoid pit wear, TSA for dishes brachial joint continued instability and glenoid pit prosthetic device relaxation
5 the market of shoulder articulation replacing
The cost of wellness attention is increasing every twelvemonth. There is a turning demand that the costs of intervention be justified by proved measuring of quality of life betterment. In finding the appropriate use for joint replacing surgery, and therefore specifying its function in the intervention of degenerative upsets, effectiveness rating is critical. Entire joint replacing has become a feasible option for immature, middle-aged, and aged patients who want to prolong athletically active life styles. Although shoulder arthroplasty can break easiness serious shoulder joint disease patients clinical symptoms and better with shoulder map, but at present the application more focal point on low to the map demand of the aged patients. And in the clinical pattern of many immature and middle-aged patients because of the serious harm to the same shoulder surgery. The traditional surgery, ankle arthrodesis and joint operation from off the serious influence shoulder articulation map and patient quality of life, immature and middle-aged patients to joint functional demand is high, the more hope the shoulder arthroplasty. To handle immature and middle-aged patients with shoulder joint replacing, clinicians ever hold more conservative. on the one manus, because of the shoulder articulation is the whole organic structure of big articulations activity scope biggest articulations, its activity strength, more easy to do prosthetic device relaxation and wear, particularly glenoid pit false organic structure parts, shorten the prosthetic device life ; On the other manus because of shoulder articulation inspection and repair engineering non mature. But there are besides clinicians claims for immature and middle-aged patients with shoulder arthroplasty, because: ( 1 ) Tell from the map upper limbs than lower limbs are more likely to avoid weight factors, can cut down false organic structure wear ; ( 2 ) from the surgery manner, ankle arthrodesis and joint from off the shoulder articulation map BASIC is lost, the serious influence patients quality of life, and shoulder arthroplasty can maintain a certain extent with shoulder map, better the quality of life. Burroughs [ 31 ] on 19 instances of average age, 38.6 old ages of the immature and middle-aged patients with shoulder joint replacing therapy, after a average followup of 5.6 old ages, and from diseases and surgical types of categorization treatment. The consequences showed that patients postoperative shoulder articulation map and quality of life improved, no postoperative shoulder articulation map impairment, and TSA is HA has good healing consequence. Sperling [ 32 ] reported so far the longest followup were the consequences of the survey, this survey included 78 patients with HA and 36 instances of patients with TSA, age are & lt ; fifty old ages old, and a average followup of 16.8 old ages. The consequences showed that HA and TSA on hurting alleviation and functional betterment of all can obtain long-run, steady consequence, HA a TSA in quality of life better healing consequence, but the outlook of life is comparatively short and overhaul rate is higher. He thought that should be based on the single state of affairs of patients with disease patterned advance and take the right manner of replacing. At present shoulder arthroplasty can do immature and middle-aged patients get better and stable forecast, But for the immature and middle-aged patients with TSA or HA, is still controversial.
At present, the shoulder arthroplasty is still has many jobs, the chosen replacing engineering, fixed method and stuffs to acquire the best healing consequence, still necessitate big multicenter randomized controlled tests and long-run follow-up observation. A hot topographic point in the survey of many focal point on glenoid pit portion ; Shoulder joint prosthetic device system are largely based on western people study design, with the popularisation and application of engineering in our state, how to plan a more suited for China 's patients with shoulder articulation prosthetic device system ; Whether can utilize tissue technology theory and material better work out the glenoid pit surface angioplasty are faced with the job ; For joint map of the high demand on the immature and middle-aged patients, how can break better the long-run forecast. All these need farther research to better and corroborate.
LUGLI, TOMASO M.D, Artificial Shoulder Joint by Pean ( 1893 ) : The Facts of an Exceptional Intervention and the Prosthetic Method, Clinical Orthopaedics & A ; Related Research: June 1978 - Volume 133 - Issue - ppg 215-218
Krishnan SG, Nowinski RJ, Harrison D, et Al. Humeral hemiarthro plasty with biologic resurfacing of the glenoid for glenohumeral arthritis-Two to fi fteen-year results. J Bone Joint Surg ( Am ) , 2007, 89 ( 4 ) : 727-734.
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