腋窝位视图：关节炎盂肱解剖结构及扩髓打压植骨后的改变。
Axillary view: arthritic glenohumeral anatomy and changes after ream and run.
机构信息
Department of Orthopedics and Sports Medicine, University of Washington, Box 356500, 1959 NE Pacific Street, Seattle, WA, 98195, USA,
出版信息
Clin Orthop Relat Res. 2014 Mar;472(3):894-902. doi: 10.1007/s11999-013-3327-6. Epub 2013 Oct 18.
BACKGROUND
The technique and results of shoulder arthroplasty are influenced by glenohumeral pathoanatomy. Although some authors advocate a routine preoperative CT scan to define this anatomy, ordering a CT scan substantially increases the cost and the radiation exposure for the patient.
QUESTIONS/PURPOSES: We asked whether measurements of arthritic shoulders on a standardized axillary view are reliable; if postoperative radiographs can reliably show the changes in glenoid anatomy and glenohumeral relationships after shoulder arthroplasty, and if the axillary view can show differences in glenohumeral pathoanatomy in the different sexes and disease types.
METHODS
These questions were addressed using cross-sectional studies of 344 shoulders with different types of arthritis and of 128 osteoarthritic shoulders having a ream and run arthroplasty (a glenohumeral arthroplasty that combines a noncemented humeral hemiarthroplasty with concentric reaming of the glenoid bone without implantation of a prosthetic glenoid component). Measurements of glenoid type, glenoid version, and glenohumeral contact were made on standardized axillary radiographs. Interobserver reliability was calculated, preoperative and postoperative measurements were compared, and morphologic differences were compared as stratified by sex and disease type.
RESULTS
The measurements on axillary views showed a high degree of interobserver reliability and sensitivity to the changes effected by arthroplasty. The ream and run substantially corrected the glenoid type and point of glenohumeral contact. Male shoulders and shoulders with osteoarthritis had more type B glenoids (ie, those with posterior erosion and biconcavity of the glenoid), more retroversion, and a greater degree of posterior displacement of the point of glenohumeral contact.
CONCLUSIONS
The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan.
LEVEL OF EVIDENCE
Level IV, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
肩关节置换术的技术和效果受到肩盂肱解剖结构的影响。虽然有些作者主张术前常规行 CT 扫描以明确该解剖结构，但 CT 扫描会显著增加患者的费用和辐射暴露。
问题/目的：我们想知道在标准腋位片上测量关节炎性肩的结果是否可靠；术后 X 线片是否能可靠地显示肩关节置换术后盂肱解剖结构和盂肱关系的变化；以及腋位片能否显示不同性别和疾病类型的盂肱解剖异常。
方法
采用不同类型关节炎的 344 例肩关节和 128 例骨关节炎行磨锉打压肱骨头成形术（一种盂肱关节置换术，即非骨水泥肱骨头半关节成形术联合盂骨的同心磨锉，不植入人工盂肱关节假体）的肩关节的横断面研究来解决这些问题。在标准腋位 X 线片上测量盂肱关节类型、盂肱关节倾斜角和盂肱关节接触情况。计算了观察者间的可靠性，比较了术前和术后的测量值，并根据性别和疾病类型进行了形态差异的分层比较。
结果
腋位片上的测量结果具有高度的观察者间可靠性和对关节置换术引起的变化的敏感性。磨锉打压肱骨头成形术显著矫正了盂肱关节类型和盂肱关节接触点。男性肩和骨关节炎肩的 B 型盂肱关节（即盂肱关节后缘侵蚀和盂肱关节双凹）更多、盂肱关节后倾更大，盂肱关节接触点后移程度更大。
结论
腋位片为术前和术后盂肱关节解剖结构的评估提供了一种实用的方法，与 CT 扫描相比，该方法成本更低，辐射暴露更少。
证据等级
IV 级，诊断研究。请参阅作者须知，以获取完整的证据等级描述。
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