Kozono Naoya, Okada Takamitsu, Takeuchi Naohide, Hamai Satoshi, Higaki Hidehiko, Shimoto Takeshi, Ikebe Satoru, Gondo Hirotaka, Nakanishi Yoshitaka, Senju Takahiro, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1, Matsukadai, Higashi-ku, Fukuoka City, Fukuoka, 813-8503, Japan.
J Orthop Surg Res. 2018 Jan 11;13(1):9. doi: 10.1186/s13018-017-0709-6.
No clear trend has emerged from the literature regarding three-dimensional (3D) translations of the humerus relative to the scapula in shoulders with rotator cuff tears (RCTs). The purpose of this study was to evaluate the kinematics of RCT shoulders using 3D-to-two-dimensional (2D) model-to-image registration techniques.
Dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 RCT patients and 10 healthy control subjects. We measured the 3D kinematic parameters of glenohumeral joints using X-ray images and CT-derived digitally reconstructed radiographs.
For scapular plane abduction, the humeral head center was positioned significantly more medially in shoulders with RCTs than in controls at 135° of humeral abduction (p = 0.02; RCTs versus controls: - 0.9 ± 1.6 versus 0.3 ± 1.3 mm). There was no significant difference in the superior/inferior translation of the humeral head center (p = 0.99). For axial rotation in adducted position, the humeral head center was positioned significantly more anteriorly in shoulders with RCTs than in controls at - 30° of glenohumeral external rotation (p < 0.0001; RCTs versus controls: 3.0 ± 1.7 versus 0.3 ± 1.5 mm).
This study revealed the kinematics of shoulders with large to massive full-thickness RCTs: the humeral head center showed a medial shift at the late phase of scapular plane full abduction, and an anterior shift at the internal rotation position during full axial rotation. The kinematic data in this study, which describe the patterns of movement of shoulders with large to massive full-thickness RCTs, provide valuable information for future studies investigating glenohumeral translations in other pathological conditions of the shoulder. For clinical relevance, quantitative assessment of the dynamic kinematics of shoulders with RCTs might be a therapeutic indicator for achieving functional restoration.
关于肩袖撕裂（RCT）患者肩部中肱骨相对于肩胛骨的三维（3D）平移，文献中尚未出现明确的趋势。本研究的目的是使用三维到二维（2D）模型到图像配准技术评估RCT肩部的运动学。
分析了11例RCT患者和10名健康对照者在肩胛平面外展和轴向旋转过程中的动态盂肱运动学。我们使用X线图像和CT衍生的数字重建X线片测量盂肱关节的三维运动学参数。
对于肩胛平面外展，在肱骨外展135°时，RCT肩部的肱骨头中心位置明显比对照组更靠内侧（p = 0.02；RCT组与对照组：-0.9±1.6对0.3±1.3毫米）。肱骨头中心的上下平移无显著差异（p = 0.99）。对于内收位的轴向旋转，在盂肱关节外旋-30°时，RCT肩部的肱骨头中心位置明显比对照组更靠前（p < 0.0001；RCT组与对照组：3.0±1.7对0.3±1.5毫米）。
本研究揭示了大到巨大全层RCT肩部的运动学：肱骨头中心在肩胛平面完全外展后期出现内侧移位，在完全轴向旋转时内旋位出现前移位。本研究中的运动学数据描述了大到巨大全层RCT肩部的运动模式，为未来研究肩部其他病理状况下的盂肱平移提供了有价值的信息。对于临床相关性而言，对RCT肩部动态运动学的定量评估可能是实现功能恢复的治疗指标。
