Favard L, Berhouet J, Walch G, Chaoui J, Lévigne C
Orthopédie 1, CHU Trousseau, 37044, Tours, France.
Centre Orthopédique Santy, Hôpital Jean Mermoz, Lyon, France.
Orthopade. 2017 Dec;46(12):1015-1021. doi: 10.1007/s00132-017-3496-1.
Correct anatomical alignment of the glenoid component is of central importance for wear and loosening in shoulder endoprostheses. The aim of this article is to review and clarify the biomechanical and clinical effects of incorrect glenoid inclination in reverse and anatomical joint replacements. Based on the literature and on our own work, statements are made about the following: (1) the glenoid inclination of a normal glenoid, a degenerative glenoid and a glenoid implant, and the consequences if superior inclination is too large, and (2) the surgical technique as well as tips and tricks for correct adjustment of the inclination. The inclination of the glenoid plane is a morphological parameter of the scapula with high individual variation and is best measured using reformatted computed tomography using three-dimensional software for reconstruction and evaluation. The standard value is between 0 and 10°. Excessive superior inclination promotes translation of the humeral head and the formation of rotator cuff tears-in a degenerative glenoid, to superior wear. The correct amount of superior inclination of the glenoid component is essential for the survival of the implant. Positioning without excessive superior inclination is therefore mandatory. Precise preoperative determination of glenoid inclination and wear is important in order to correctly plan the positioning of an implant. This serves as the basis for deciding whether a bone graft or patient-specific instrumentation is necessary. Thus, the surgeon also has prognostic parameters for the anticipation of possible complications as a result of the bone defect and abnormal orientation. However, the evaluation must always include the position of the scapula in these considerations.
关节盂部件的正确解剖学对线对于肩关节假体的磨损和松动至关重要。本文旨在回顾和阐明反向和解剖型关节置换中关节盂倾斜不正确的生物力学和临床影响。基于文献和我们自己的工作，对以下方面进行阐述：(1)正常关节盂、退变关节盂和关节盂植入物的关节盂倾斜度，以及上倾角过大的后果；(2)手术技术以及正确调整倾斜度的技巧和窍门。关节盂平面的倾斜度是肩胛骨的一个形态学参数，个体差异很大，最好使用三维软件重建和评估的重组计算机断层扫描来测量。标准值在0°至10°之间。上倾角过大易导致肱骨头移位和肩袖撕裂的形成——在退变的关节盂中，易导致上方磨损。关节盂部件正确的上倾角对于植入物的存活至关重要。因此，必须无过大上倾角地进行定位。术前精确测定关节盂倾斜度和磨损情况对于正确规划植入物的定位很重要。这是决定是否需要植骨或使用定制器械的基础。因此，外科医生也有了预测参数，可据此预判由于骨缺损和异常方向可能出现的并发症。然而，在这些考量中，评估必须始终包括肩胛骨的位置。
