Routman Howard D
Bull Hosp Jt Dis (2013). 2013;71 Suppl 2:108-12.
Controversy surrounds the role of the sub- scapularis (SSC) in reverse shoulder arthroplasty (rTSA) and the need for repair, if possible, at the conclusion of the procedure. QUESTIONS AND PURPOSE: Some investigators have concluded that an intact SSC is critical for stability; others have found no such correlation. What factors should be part of the decision-making matrix on SSC management for surgeons considering rTSA?
The data on management of the SSC in rTSA support a design-based approach. Researchers have shown that the SSC is critical to stability when the surgeon uses an implant with a medialized humeral component and medialized glenoid component. However, lateralized designs allow for more stability from horizontal deltoid compression and may not require repair of the SSC. In addition, SSC repair has been shown to increase the workload of the residual posterior rotator cuff and the deltoid in rTSA, both of which may have negative consequences on overall function. Lateralization from the glenoid component increases deltoid work, whereas lateralization from the humeral component maintains deltoid efficiency while improving stability.
The need for SSC repair in rTSA can vary based on the implant selected. Humeral and glenoid offset influence the stability and kinematics of rTSA.
肩胛下肌（SSC）在反肩关节置换术（rTSA）中的作用以及手术结束时是否需要修复（若可能）存在争议。
一些研究者得出结论，完整的肩胛下肌对稳定性至关重要；另一些人则未发现这种相关性。对于考虑进行反肩关节置换术的外科医生而言，在肩胛下肌管理的决策矩阵中，哪些因素应被纳入？
反肩关节置换术中肩胛下肌管理的数据支持基于设计的方法。研究人员表明，当外科医生使用肱骨组件内移和关节盂组件内移的植入物时，肩胛下肌对稳定性至关重要。然而，外移设计通过水平三角肌压缩可实现更高的稳定性，可能不需要修复肩胛下肌。此外，在反肩关节置换术中，已证明修复肩胛下肌会增加残余后肩袖和三角肌的工作量，这两者都可能对整体功能产生负面影响。关节盂组件外移会增加三角肌的工作量，而肱骨组件外移在提高稳定性的同时保持三角肌的效率。
反肩关节置换术中肩胛下肌修复的必要性可能因所选植入物而异。肱骨和关节盂偏移会影响反肩关节置换术 的稳定性和运动学。
