Kanazawa Kenji, Hagiwara Yoshihiro, Kawai Nobuaki, Sekiguchi Takuya, Koide Masashi, Ando Akira, Sugaya Hiroyuki, Itoi Eiji
Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
J Shoulder Elbow Surg. 2017 Feb;26(2):233-240. doi: 10.1016/j.jse.2016.09.016. Epub 2016 Nov 2.
Evaluation of range of motion (ROM) restriction before treatment of shoulder disorders is important for predicting the final functional outcomes. The purpose of this study was to investigate correlations of thickness of the coracohumeral ligament (CHL) and ROM restriction in patients with recurrent anterior glenohumeral instability.
Between January 2005 and March 2015, 181 shoulders (137 male and 44 female patients; mean age, 29.3 years) with recurrent anterior glenohumeral instability treated with an arthroscopic Bankart repair were enrolled in this study. We evaluated preoperative ROM, thickness of the CHL, and obliteration of the subcoracoid fat triangle on magnetic resonance arthrography. ROM measurements, including forward flexion (FF), external rotation with the arm at the side (ER), and hand behind the back (HBB), were made in a standing position.
There were significant negative correlations between FF and age (P < .001) and between HBB and age (P < .001) but not between ER and age (P = .11). The thickness of the CHL significantly increased with age (P < .001). FF, ER, and HBB were significantly restricted in patients with obliteration compared with those without obliteration (P < .001, P = .004, P < .001, respectively).
Obliteration of the subcoracoid fat triangle and the thickness of the CHL positively correlated with ROM restrictions, and these changes were greater with age in patients with recurrent anterior glenohumeral instability.
在治疗肩部疾病之前评估活动范围(ROM)受限情况对于预测最终功能结果很重要。本研究的目的是调查复发性前盂肱关节不稳患者的喙肱韧带(CHL)厚度与ROM受限之间的相关性。
2005年1月至2015年3月期间,181例接受关节镜下Bankart修复术治疗的复发性前盂肱关节不稳患者(137例男性和44例女性患者;平均年龄29.3岁)纳入本研究。我们在磁共振关节造影上评估了术前ROM、CHL厚度以及喙突下脂肪三角的消失情况。ROM测量包括站立位的前屈(FF)、上肢在体侧的外旋(ER)和手背后伸(HBB)。
FF与年龄之间(P<0.001)以及HBB与年龄之间(P<0.001)存在显著负相关,但ER与年龄之间无显著相关性(P = 0.11)。CHL厚度随年龄显著增加(P<0.001)。与未出现脂肪三角消失的患者相比,出现脂肪三角消失的患者FF、ER和HBB均显著受限(分别为P<0.001、P = 0.004、P<0.001)。
喙突下脂肪三角的消失和CHL厚度与ROM受限呈正相关,并且在复发性前盂肱关节不稳患者中,这些变化随年龄增长而更大。