Kim DooSup, Lee DongWoo, Jang YoungHwan, Yeom JunSeop, Banks Scott A
Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Gangwon, Republic of Korea; Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA.
Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Gangwon, Republic of Korea.
J Shoulder Elbow Surg. 2017 Sep;26(9):e286-e292. doi: 10.1016/j.jse.2017.03.013. Epub 2017 May 3.
Short malunion of the clavicle after fracture can change scapular kinematics and alter clinical outcome. However, the effects of malunion on kinematics and outcomes remains poorly understood because there have been no in vivo studies measuring changes during active motion with malunion. This study aimed to measure and to compare in vivo 3-dimensional (3D) scapular kinematics between normal shoulders and shoulders with short malunion using 3D-2-dimensional model image registration techniques.
Fifteen patients with clavicle fracture who had been treated conservatively were enrolled in this study. In these patients, the angle of scapular upward rotation, posterior tilting, and external rotation were compared between shoulders with short malunion and contralateral, normal shoulders. A 3D-2-dimensional model image registration technique was used to determine the 3D orientation of the scapula.
Scapular upward rotation increased following increase of the arm elevation angle and also showed a significant difference by arm elevation in both groups (P = .04). Posterior tilting of the scapula gradually increased as the arm abduction angle increased, and this varied significantly between groups (P = .01). Shoulders with short malunion also showed a more internally rotated position than the contralateral, normal shoulders between 100° and the maximum abduction angle (P = .04).
Our results suggest that clavicle shortening of >10% greatly affects scapular kinematics in vivo. Further studies will be needed to determine the clinical implications of short malunion of the clavicle.
锁骨骨折后短缩畸形愈合可改变肩胛骨的运动学并影响临床结局。然而，由于尚无体内研究测量畸形愈合情况下主动运动期间的变化，因此畸形愈合对运动学和结局的影响仍知之甚少。本研究旨在使用三维-二维模型图像配准技术测量并比较正常肩部与存在短缩畸形愈合的肩部的体内三维肩胛骨运动学。
本研究纳入了15例接受保守治疗的锁骨骨折患者。在这些患者中，比较了存在短缩畸形愈合的肩部与对侧正常肩部的肩胛骨向上旋转、后倾和外旋角度。使用三维-二维模型图像配准技术确定肩胛骨的三维方向。
随着手臂抬高角度增加，肩胛骨向上旋转增加，两组中手臂抬高时也均显示出显著差异（P = 0.04）。随着手臂外展角度增加，肩胛骨后倾逐渐增加，且两组间差异显著（P = 0.01）。在100°至最大外展角度之间，存在短缩畸形愈合的肩部也比其对侧正常肩部表现出更内旋的位置（P = 0.04）。
我们的结果表明，锁骨缩短超过10%会在体内极大地影响肩胛骨运动学。需要进一步研究以确定锁骨短缩畸形愈合的临床意义。
