Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Physical Medicine and Rehabilitation, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Physical Medicine and Rehabilitation, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, UFR des Saints-Pères, Paris, France.
Musculoskelet Sci Pract. 2017 Jun;29:84-90. doi: 10.1016/j.msksp.2017.03.006. Epub 2017 Mar 20.
The movement of the arm relative to the trunk results from coordinated 3D glenohumeral and scapulothoracic movements. Changes in scapula kinematics may occur after total shoulder arthroplasty and could affect clinical and functional outcomes.
To assess the 3D movement of the scapula during arm elevation after anatomic and reverse total shoulder arthroplasty.
DESIGN/METHODS: This was a single-centre, non-randomized, controlled cross-sectional study. Patients with anatomic (n = 14) and reverse total shoulder arthroplasty (n = 9) were prospectively enrolled and were compared to age-matched asymptomatic controls (n = 23). 3D scapular kinematics were assessed by a non-invasive, electromagnetic method during arm abduction and flexion. 3D scapular rotations and 3D linear displacements of the barycentre (geometrical centre) at rest and at 30°, 60° and 90° arm elevation; as well as scapulohumeral rhythm were analysed. Participant groups were compared using one-way ANOVA and Bonferroni post-hoc testing for normally distributed data, and Mann-Whitney U test for non-normally distributed data.
RESULTS/FINDINGS: Total range of scapular lateral rotation and barycentre displacement were increased, and scapulohumeral rhythm was reduced, in patients with anatomic and reverse total shoulder arthroplasty compared with age-matched controls; however, the global scapular kinematic pattern was preserved.
CONCLUSION/INTERPRETATION: For patients after total shoulder arthroplasty, the increased contribution of the scapula to arm elevation is consistent with a compensatory mechanism for the reduced glenohumeral mobility. The stability of the global scapula kinematic pattern reflects its mechanical and neuromotor strength.
手臂相对于躯干的运动是由肩胛胸壁和盂肱关节协调的三维运动产生的。全肩关节置换术后，肩胛骨运动学可能会发生变化，并可能影响临床和功能结果。
评估全肩关节置换术后肩关节外展时肩胛骨的三维运动。
设计/方法：这是一项单中心、非随机、对照的横断面研究。前瞻性纳入解剖型（n=14）和反式全肩关节置换术（n=9）患者，并与年龄匹配的无症状对照组（n=23）进行比较。在肩关节外展和前屈过程中，采用非侵入性电磁方法评估三维肩胛骨运动学。分析休息时和肩关节外展 30°、60°和 90°时的三维肩胛骨旋转和重心（几何中心）的三维线性位移，以及肩胛胸节律。使用单向方差分析和 Bonferroni 事后检验比较正态分布数据，使用 Mann-Whitney U 检验比较非正态分布数据。
结果/发现：与年龄匹配的对照组相比，解剖型和反式全肩关节置换术后患者的肩胛骨外侧旋转总范围和重心位移增加，肩胛胸节律降低；然而，整体肩胛骨运动模式得以保留。
结论/解释：对于全肩关节置换术后的患者，肩胛骨对肩关节外展的贡献增加与盂肱关节活动度降低的代偿机制一致。整体肩胛骨运动模式的稳定性反映了其机械和神经运动力量。
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