German Shoulder Centre, ATOS Clinic Munich, Munich, Germany.
German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
J Shoulder Elbow Surg. 2017 Dec;26(12):2193-2199. doi: 10.1016/j.jse.2017.07.009. Epub 2017 Sep 21.
The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head.
The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads.
In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%.
It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.
本研究旨在描述骨关节炎肱骨头的病理变化。
本研究纳入了 55 例因原发性骨关节炎而行解剖肩袖关节置换术的患者。对多项影像学参数（X 线、磁共振成像）进行了评估。选择从切除的肱骨头中进行冠状面的肱骨头横向平面的畸形和冠状面的肱骨头软骨侵蚀的摄影测量。
在冠状面，82%的患者呈现出非球形肱骨头形状，且尾侧骨赘明显更长。在横断面上，50%的患者表现为中心突出。在横断面上表现出非球形肱骨头形状的患者，在冠状面上有 94%表现出非球形肱骨头形状，且骨赘明显更长，这表明原发性骨关节炎进展过程中肱骨头存在三维畸形。骨赘长度在 7 至 12mm 之间的患者与盂唇 B2 型的发生率为 30%，横断面上中心突出的发生率为 38%。骨赘长度大于 13mm 的患者与盂唇 B2 型的相关性显著增加（71%；P<0.0001），且横断面上中心突出的发生率为 52%。
似乎盂肱关节原发性骨关节炎的进展特征是与盂唇形态相关的肱骨头三维畸形不断增加。因此，我们提出了一种扩展的 Samilson-Prieto 分类，分为 A 型（球形）和 B 型（非球形）以及 I-IV 级骨赘。
