Konrad Gerhard G, Markmiller Max, Jolly John T, Ruter Axel E, Sudkamp Norbert P, McMahon Patrick J, Debski Richard E
Department of Orthopaedic and Trauma Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
Clin Biomech (Bristol). 2006 Nov;21(9):942-9. doi: 10.1016/j.clinbiomech.2006.04.013. Epub 2006 Jun 15.
A massive rotator cuff tear leads to poor shoulder function as evidenced by diminished glenohumeral abduction and superior translation of the humeral head compared to its normal position. The inclination angle of the glenoid has been associated with rotator cuff tears. The objective of this study was to quantify the effect of a decreased glenoid inclination angle on glenohumeral kinematics during active abduction in shoulders with a simulated, massive rotator cuff tear.
Eight fresh-frozen full upper extremities were tested using a dynamic shoulder testing apparatus. After recording the kinematics of the intact shoulder, a massive rotator cuff tear was surgically simulated. An osteotomy of the glenoid was then performed and the inclination angle was decreased by 30 degrees . The translation of the humeral head during abduction and the maximum abduction angle were recorded.
With an intact rotator cuff minimal humeral head translation on the glenoid occurred and the maximum abduction angle was mean 85.5 degrees (SD 7.4 degrees ). A massive rotator cuff tear resulted in superior translation of the humeral head with impingement on the acromion. The maximum abduction angle was mean 15.5 degrees (SD 9.4 degrees ). Decreasing the inclination angle of the glenoid resulted in a significant reduction of superior humeral head translation during abduction and there was no impingement on the acromion. The maximum abduction achieved was mean 28.5 degrees (SD 17.0 degrees ).
From a clinical perspective the reduced superior translation may decrease shoulder pain since the humeral head no longer impinges on the acromion. Further investigations are necessary to assess if the improvement in abduction is clinically significant.
巨大的肩袖撕裂会导致肩部功能不佳，与正常位置相比，肩肱关节外展减少和肱骨头向上移位可证明这一点。肩胛盂倾斜角与肩袖撕裂有关。本研究的目的是量化在模拟巨大肩袖撕裂的肩部主动外展过程中，肩胛盂倾斜角减小对肩肱关节运动学的影响。
使用动态肩部测试装置对8个新鲜冷冻的完整上肢进行测试。记录完整肩部的运动学后，手术模拟巨大肩袖撕裂。然后进行肩胛盂截骨术，将倾斜角减小30度。记录外展过程中肱骨头的移位和最大外展角度。
肩袖完整时，肱骨头在肩胛盂上的移位最小，最大外展角度平均为85.5度（标准差7.4度）。巨大肩袖撕裂导致肱骨头向上移位并撞击肩峰。最大外展角度平均为15.5度（标准差9.4度）。减小肩胛盂倾斜角导致外展过程中肱骨头向上移位显著减少，且未撞击肩峰。实现的最大外展角度平均为28.5度（标准差17.0度）。
从临床角度来看，向上移位减少可能会减轻肩部疼痛，因为肱骨头不再撞击肩峰。需要进一步研究来评估外展改善在临床上是否具有显著意义。
