Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.
St Luke's Northland Hospital, Kansas City, Missouri, USA.
Orthop J Sports Med. 2014 Nov 10;2(11):2325967114556257. doi: 10.1177/2325967114556257. eCollection 2014 Nov.
Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes.
To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation.
Descriptive laboratory study.
Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face.
Progressing in the clockwise direction, beginning at the 12:00 position, the safe insertion ranges (mean ± SD ) were 55.9° ± 10.6°, 63.6° ± 17.6°, 47.7° ± 9.1°, 46.1° ± 8°, 73.9° ± 9.7°, 40.9° ± 6.5°, 40.4° ± 7.4°, and 39.9° ± 7.1°, respectively. The optimal insertion angles were 47.9° ± 7.6°, 53.1° ± 10.9°, 35.0° ± 4.4°, 42.4° ± 4.9°, 60.9° ± 8.4°, 36.6° ± 5.9°, 31.2° ± 4.9°, 34.8° ± 4.6°, respectively.
Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face. The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid. A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.
Proper arthroscopic technique resulting in anchor insertion at the correct angle, depth, and location will prevent anchor-related glenohumeral complications such as glenoid perforation, cartilage damage, persistent pain, decreased range of motion, and failure of the reconstruction.
肩盂唇撕裂常需要使用锚钉修复。关节镜下锚钉的放置具有挑战性，锚钉位置不当可能会使手术结果复杂化。
确定在肩胛盂边缘的不同位置进行肩盂唇锚钉插入的安全插入范围和最佳插入角度，并制定可降低锚钉穿透风险的手术指南。
描述性实验室研究。
对 30 例正常尸体标本进行三维 CT 扫描。在肩胛盂边缘的钟面位置（代表 12:00、1:30、3:00、4:30、6:00、7:30、9:00 和 10:30），将通用肩盂唇锚钉的虚拟模型插入肩胛盂边缘。在每个位置，安全插入范围是测量的最大范围，最佳插入角度定义为安全插入范围的平分线与肩胛盂面之间的角度。
从 12:00 位置开始，按顺时针方向，安全插入范围（平均值±标准差）分别为 55.9°±10.6°、63.6°±17.6°、47.7°±9.1°、46.1°±8.0°、73.9°±9.7°、40.9°±6.5°、40.4°±7.4°和 39.9°±7.1°。最佳插入角度分别为 47.9°±7.6°、53.1°±10.9°、35.0°±4.4°、42.4°±4.9°、60.9°±8.4°、36.6°±5.9°、31.2°±4.9°和 34.8°±4.6°。
与肩胛盂面的位置相比，最佳插入角度和安全插入范围有显著差异。与后肩胛盂相比，前肩胛盂的安全插入范围和最佳插入角度更宽。10:30 位置时，后外侧入路角度比前入路角度更安全。
正确的关节镜技术可使锚钉以正确的角度、深度和位置插入，从而预防与锚钉相关的盂肱关节并发症，如肩胛盂穿透、软骨损伤、持续性疼痛、活动范围减小和重建失败。
