Sabesan Vani, Callanan Mark, Sharma Vinay, Wiater J Michael
Department of Orthopedic Surgery, Wayne State University School of Medicine, Dearborn, MI.
Am J Orthop (Belle Mead NJ). 2015 May;44(5):E148-52.
There has been increased focus on understanding risk factors for scapular notching in reverse shoulder arthroplasty (RSA). We conducted a study to evaluate the scapular notching index and other factors associated with the occurrence of scapular notching. Ninety-one patients treated with primary RSA were followed for a minimum of 24 months. Patients' radiographic assessments were grouped by Nerot grade of scapular notching (group 1, grades 0 and 1; group 2, grades 2, 3, 4). Group mean differences were compared for preoperative scapular neck angle (SNA), prosthesis-scapular neck angle (PSNA), peg glenoid rim distance (PGRD), notching index, and clinical outcomes. There was no significant difference in mean (SD) notching index between group 1, 31.8 (4.4), and group 2, 33.1 (7.3), and there were no significant differences in SNA (102.8° vs 105.4°; P=.3), PSNA (125.8° vs 125.4°; P=.82), PGRD (15.4 vs 16.8 mm; P=.47), or clinical outcomes between the groups. Our results suggest that Grammont-style prostheses have a higher rate of notching regardless of optimal PGRD and variations in PSNA. Perhaps with certain scapular morphology, prosthetic design may be a more significant contributor to notching.
在反肩关节置换术（RSA）中，人们越来越关注肩胛切迹的危险因素。我们进行了一项研究，以评估肩胛切迹指数及与肩胛切迹发生相关的其他因素。对91例行初次RSA治疗的患者进行了至少24个月的随访。根据肩胛切迹的Nerot分级对患者的影像学评估进行分组（第1组，0级和1级；第2组，2级、3级、4级）。比较两组术前肩胛颈角（SNA）、假体-肩胛颈角（PSNA）、钉-关节盂边缘距离（PGRD）、切迹指数及临床结果的组均值差异。第1组的平均（标准差）切迹指数为31.8（4.4），第2组为33.1（7.3），两组之间无显著差异；两组之间的SNA（102.8°对105.4°；P = 0.3）、PSNA（125.8°对125.4°；P = 0.82）、PGRD（15.4对16.8 mm；P = 0.47）或临床结果也无显著差异。我们的结果表明，无论PGRD是否最佳以及PSNA如何变化，Grammont型假体的切迹发生率都较高。也许在某些肩胛形态下，假体设计可能是导致切迹的更重要因素。
