von Eisenhart-Rothe R, Graichen H, Mayr H O, Jäger A, Wiedemann E, Hinterwimmer S
Klinik für Orthopädie und Unfallchirurgie, Klinikum Rechts der Isar der TU München.
Sportverletz Sportschaden. 2009 Jun;23(2):106-11. doi: 10.1055/s-0028-1109507. Epub 2009 Jun 8.
Changes in glenoid orientation as a primary cause of shoulder instability have been discussed controversially in the literature. The data of a physiological glenoid version vary widely among different authors and techniques. One reason may be that the previously used 2-D techniques suffer from a limited reproducibility and validity. The objective of this study was therefore to compare the 2-D and 3-D analyses of the glenoid version in patients with shoulder instability.
The shoulders of 28 healthy volunteers and of 14 patients each with atraumatic/traumatic instability were examined in an open MR scanner (0.2 T). The 2-D glenoid version was determined using post-processing techniques according to the technique of Friedman et al. (1992). Afterwards, the 3-D glenoid version was analysed independently of the slice orientation and patient position. The coefficient of correlation (r) between the 2-D and 3-D glenoid versions was calculated using the correlation z test.
The 3-D post-processing technique showed a reproducibility with a coefficient of variation of 8.3 %. Patients with traumatic instability demonstrated no significant difference compared to the healthy control group (4.4 +/- 2.1 degrees vs. healthy: 3.9 +/- 1.3 degrees). In atraumatic shoulder instability the glenoid retroversion was in the mean significantly increased (10.2 +/- 4.9 degrees). The individual values ranged between 2.6 degrees and 16.6 degrees . Also for the contralateral, unaffected side a significantly increased retroversion (6.3 +/- 2.2 degrees) was observed compared to healthy shoulders. There was a significant correlation (r: 0.84) between 2-D and 3-D retroversion.
The presented techniques allow for a reproducible assessment of glenoid version independent of the slice orientation and patient position. Our results demonstrate in the mean only a small difference of +/- 3 degrees between 2-D and 3-D glenoid versions. Therefore under standardised conditions the 2-D CT/MRI should be adequate for measuring the glenoid version except for borderline cases. No significant changes in glenoid version were found in patients with traumatic instability. In atraumatic, posterior instability, in the mean an increased retroversion was observed on both sides. However, the magnitude of these changes varied widely among individuals and should be identified to initiate a causal treatment.
肩胛盂方向改变作为肩关节不稳的主要原因在文献中一直存在争议。不同作者和技术所报道的生理性肩胛盂倾斜度数据差异很大。一个原因可能是之前使用的二维技术的可重复性和有效性有限。因此，本研究的目的是比较肩关节不稳患者肩胛盂倾斜度的二维和三维分析。
在一台开放式磁共振扫描仪（0.2T）中对28名健康志愿者以及14例分别患有非创伤性/创伤性肩关节不稳的患者的肩部进行检查。根据Friedman等人（1992年）的技术，使用后处理技术确定二维肩胛盂倾斜度。之后，独立于层面方向和患者体位分析三维肩胛盂倾斜度。使用相关性z检验计算二维和三维肩胛盂倾斜度之间的相关系数（r）。
三维后处理技术显示出可重复性，变异系数为8.3%。创伤性肩关节不稳患者与健康对照组相比无显著差异（4.4±2.1度 vs. 健康组：3.9±1.3度）。在非创伤性肩关节不稳中，肩胛盂后倾平均显著增加（10.2±4.9度）。个体值范围在2.6度至16.6度之间。与健康肩部相比，对侧未受影响的一侧也观察到后倾显著增加（6.3±2.2度）。二维和三维后倾之间存在显著相关性（r：0.84）。
所介绍的技术能够独立于层面方向和患者体位对肩胛盂倾斜度进行可重复评估。我们的结果显示，二维和三维肩胛盂倾斜度平均仅相差±3度。因此，在标准化条件下，除临界病例外，二维CT/MRI应该足以测量肩胛盂倾斜度。创伤性肩关节不稳患者未发现肩胛盂倾斜度有显著变化。在非创伤性、后方不稳中，平均两侧均观察到后倾增加。然而，这些变化的程度在个体间差异很大，应予以识别以便进行针对性治疗。
