Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
Clin Orthop Relat Res. 2012 Aug;470(8):2193-201. doi: 10.1007/s11999-012-2291-x. Epub 2012 Feb 24.
Osteotomy of the lesser tuberosity in shoulder arthroplasty allows bony healing of the subscapularis tendon but does not prevent fatty degeneration in its muscle. Occurrence or increase in fatty degeneration may depend on the surgical technique.
QUESTIONS/PURPOSES: We (1) assessed fatty degeneration in the subscapularis muscle and its cross-sectional area after a C-block osteotomy of the lesser tuberosity with minimal mobilization of the subscapularis muscle, and (2) determined whether this technique had any adverse effect on function, fatty degeneration, and cross-sectional area of the subscapularis muscle.
We retrospectively examined 36 patients with shoulder replacements who had C-block osteotomies. Constant-Murley scores and clinical signs of subscapularis insufficiency were recorded. We radiographically assessed prosthetic placement. On CT scans, lesser tuberosity healing, fatty degeneration, and cross-sectional area of the subscapularis muscle were determined. The minimum followup was 13 months (mean, 18 months; range, 13-33 months).
The mean absolute Constant-Murley score was 71.2. Two patients had weakness of the subscapularis muscle without loss of active motion. All tuberosities healed anatomically. A normal glenohumeral relationship was found in all cases. Fatty degeneration was Grade 0 in 44%, Grade 1 in 39%, Grade 2 in 14%, and Grade 3 in 3%. The subscapularis muscular cross-sectional area decreased from 16.7 cm(2) preoperatively to 14.5 cm(2) postoperatively (13%).
The C-block osteotomy with minimal dissection of the subscapularis is associated with a low incidence of fatty degeneration in the subscapularis muscle after shoulder arthroplasty although the muscular cross-sectional area of the subscapularis decreased.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
肩关节置换术中对小结节的截骨术允许肩胛下肌腱的骨愈合，但不能防止其肌肉的脂肪变性。脂肪变性的发生或增加可能取决于手术技术。
问题/目的：我们（1）评估了在小结节的 C 型截骨术中，肩胛下肌的最小移动后肩胛下肌的脂肪变性及其横截面积，以及（2）确定该技术是否对功能、肩胛下肌的脂肪变性和横截面积有任何不利影响。
我们回顾性地检查了 36 例接受肩部置换术的患者，他们均接受了 C 型截骨术。记录 Constant-Murley 评分和肩胛下肌不足的临床体征。我们对假体的位置进行放射评估。在 CT 扫描上，确定小结节愈合、脂肪变性和肩胛下肌的横截面积。最小随访时间为 13 个月（平均随访时间为 18 个月；范围为 13-33 个月）。
平均绝对 Constant-Murley 评分为 71.2。有 2 例患者肩胛下肌无力，但无主动运动丧失。所有的小结节都愈合了。所有病例的盂肱关节关系均正常。脂肪变性分级为 0 级占 44%，1 级占 39%，2 级占 14%，3 级占 3%。肩胛下肌的横截面积从术前的 16.7cm²减少到术后的 14.5cm²（减少了 13%）。
在肩关节置换术中，与肩胛下肌的最小解剖分离相关的 C 型截骨术，尽管肩胛下肌的横截面积减小，但肩胛下肌的脂肪变性发生率较低。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
