肩胛倾斜度和关节盂版本变异的研究——术前规划的考量：临床放射学研究
Study of the variability of scapular inclination and the glenoid version - considerations for preoperative planning: clinical-radiological study.
作者信息
Fulin Petr, Kysilko Martin, Pokorny David, Padr Radek, Kasprikova Nikola, Landor Ivan, Sosna Antonin
机构信息
Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, Prague, postal code 15006, Czech Republic.
Clinic of Imaging Methods 2nd Faculty of Medicine Charles University and Motol University Hospital, Prague, Czech Republic.
出版信息
BMC Musculoskelet Disord. 2017 Jan 14;18(1):16. doi: 10.1186/s12891-016-1381-4.
BACKGROUND
Preoperative planning with the aid of imaging methods is a principal factor in successful surgery on the shoulder. This work aims to evaluate the variability of glenoid version, spiralling twist and scapular inclination in relation to the frontal axis. Studies focusing on measuring the variability of scapular inclination in the standardised rest position are lacking in the literature.
METHODS
We evaluated 104 CT scans of the shoulder. We measured the glenoid version with respect to the scapular axis at three levels. We measured the scapular inclination angle in relation to the sagittal plane and we determined scapular inclination in relation to the frontal axis. Statistical evaluation was performed using the marginal linear model and parameters were estimated using the generalised least squares method, which enables the dependency of measurements performed on the same subject to be taken into consideration.
RESULTS
The highest values of retroversion are attained by the glenoid in the cranial section (average -9.96°, range -29.7 to +13.2°). Proof of the spiralling twist is the decline in retroversion at the centre of the glenoid (average -2.09°, range -16.7 to +11.6°). Retroversion decreases further in the inferior direction (average -0.5°, range -20.9 to +17.5°). The average thoracoscapular angle is 45.46°, ranging from 13.1 to 69.0°. The average scapular inclination in relation to the frontal plane is 44.54°, ranging from 21.0 to76.9°.
CONCLUSIONS
During preoperative planning, the surgeon should take into consideration not only the glenoid version in relation to the scapular axis, but also the value of the scapular inclination so as to eliminate possible surgical errors, optimise prosthesis implantation and thus decrease the risk of functional restrictions of the joint.
CLINICAL TRIAL REGISTRATION
Ethics Committee for Multi-Centric Clinical Trials (EK-554/14,29thApril 2014).
背景
借助影像学方法进行术前规划是肩部手术成功的主要因素。本研究旨在评估肩胛盂版本、螺旋扭转以及肩胛相对于额状轴的倾斜度的变异性。文献中缺乏针对标准化休息位时肩胛倾斜度变异性测量的研究。
方法
我们评估了104例肩部CT扫描。我们在三个层面测量了肩胛盂相对于肩胛轴的版本。我们测量了肩胛相对于矢状面的倾斜角度，并确定了肩胛相对于额状轴的倾斜度。使用边际线性模型进行统计评估，并使用广义最小二乘法估计参数，该方法能够考虑到在同一受试者上进行的测量之间的相关性。
结果
肩胛盂在颅侧部分的后倾值最高（平均-9.96°，范围-29.7至+13.2°）。螺旋扭转的证据是肩胛盂中心后倾度的下降（平均-2.09°，范围-16.7至+11.6°）。在下侧方向后倾度进一步降低（平均-0.5°，范围-20.9至+17.5°）。平均胸廓肩胛角为45.46°，范围为13.1至69.0°。肩胛相对于额状面的平均倾斜度为44.54°，范围为21.0至76.9°。
结论
在术前规划过程中，外科医生不仅应考虑肩胛盂相对于肩胛轴的版本，还应考虑肩胛倾斜度的值，以消除可能的手术误差，优化假体植入，从而降低关节功能受限的风险。
临床试验注册
多中心临床试验伦理委员会（EK-554/14，2014年4月29日）。
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