Department of Orthopaedic Surgery, Michigan State University/Kalamazoo Center of Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008. E-mail address:
College of Human Medicine, Michigan State University, 321 Michigan Place N.E., Grand Rapids, MI 49503.
J Bone Joint Surg Am. 2014 Apr 16;96(8):e64. doi: 10.2106/JBJS.L.00856.
Glenoid bone loss associated with advanced glenohumeral arthritis is frequently accompanied by subluxation of the humeral head with subsequent inferior outcomes of shoulder arthroplasty. We hypothesized that the relationship between the center of the humeral head and the perpendicular to the glenoid fossa plane differs from, and is independent of, the relationship between the center of the humeral head and the plane of the scapula.
Three-dimensional computed tomography (3D CT) imaging was performed on sixty patients with advanced osteoarthritis and fifteen controls with no osteoarthritis to define the baseline relationship between the center of the humeral head and the perpendicular to the glenoid fossa plane and the plane of the scapula. Correlations between these variables and the amount of bone loss and glenoid version were assessed.
There was a strong linear relationship (p < 0.001) between glenoid retroversion and the center of the humeral head in relation to the center line of the scapula (humeral-scapular alignment). Humeral head alignment in relation to the glenoid plane (humeral-glenoid alignment) was variable and not strongly correlated with the amount of glenoid retroversion. The average glenoid retroversion for the normal shoulders was -3.5°, and the average humeral-scapular alignment offset percentage was -2.3%. The average humeral-glenoid alignment offset for the normal shoulders was 0.5 mm with an average humeral-glenoid alignment offset percentage of 0.9%.
The location of the humeral head in relation to the glenoid can be defined as displacement from the plane of the scapula and from the perpendicular of the glenoid plane. These two measures are independent of one another. The data suggest that each measurement may represent a different effect on glenoid loading.
The importance of this study is that it presents quantitative data and clear guidelines to define two measurements of glenohumeral alignment as separate and important variables. The clinical relevance of these methods will be further defined when they are correlated with clinical outcomes.
与重度肩关节炎相关的肩胛盂骨量丢失常伴有肱骨头半脱位，从而导致肩关节置换术的预后不良。我们假设，肱骨头中心与肩胛盂垂直平面之间的关系不同于且独立于肱骨头中心与肩胛盂平面之间的关系。
对 60 例晚期骨关节炎患者和 15 例无骨关节炎的对照组患者进行三维 CT 成像，以确定肱骨头中心与肩胛盂垂直平面和肩胛盂平面之间的基线关系。评估这些变量与骨量丢失和肩胛盂倾斜度之间的相关性。
在肩胛盂后倾与肱骨头相对于肩胛盂中线（肱肩对齐）之间存在很强的线性关系（p < 0.001）。肱骨头相对于肩胛盂平面（肱盂对齐）的对齐方式是可变的，并且与肩胛盂后倾的程度没有很强的相关性。正常肩的平均肩胛盂后倾为-3.5°，平均肱肩对齐偏移百分比为-2.3%。正常肩的平均肱盂对齐偏移为 0.5 毫米，平均肱盂对齐偏移百分比为 0.9%。
肱骨头相对于肩胛盂的位置可以定义为相对于肩胛盂平面和肩胛盂垂直平面的位移。这两个测量值彼此独立。数据表明，每个测量值可能代表对肩胛盂负荷的不同影响。
本研究的重要性在于它提供了定量数据和明确的指南，将肱盂对齐的两种测量定义为独立且重要的变量。当这些方法与临床结果相关联时，它们的临床相关性将进一步确定。
