Department of Shoulder and Elbow Surgery, Balgrist University Hospital, Zurich, Switzerland.
Department of Shoulder and Elbow Surgery, Balgrist University Hospital, Zurich, Switzerland.
J Shoulder Elbow Surg. 2019 Jan;28(1):22-27. doi: 10.1016/j.jse.2018.05.041. Epub 2018 Aug 31.
Anatomic factors associated with static posterior translation of the humeral head with or without glenohumeral osteoarthritis are unknown. We tested the hypothesis that there is an association between glenoid wear, glenoid version, and/or anteroposterior acromial tilt.
Ninety-nine patients with glenohumeral joint degeneration involving advanced glenoid cartilage wear and/or rotator cuff disease scheduled for anatomic or reverse total shoulder replacement underwent standardized conventional radiographic and computed tomographic shoulder imaging. Measurements included glenoid version, humeral torsion, posterior acromial slope, and critical shoulder angle. The glenoid shape was classified according to Walch et al, and the integrity of the rotator cuff was assessed.
Patients with glenoid type B2 or C had a median of 4° more glenoid retroversion (P = .022), a 5° less steep acromion (posterior acromial slope, 61° vs 56°; P = .004), and a higher combined score (glenoid version minus slope; odds ratio, 0.93 [95% confidence interval, 0.89-0.97]; P < .001; cutoff, -27°) than those with type A or B1. When the rotator cuff was torn, osteoarthritic changes were milder than when the cuff was intact (eg, P < .001 for supraspinatus).
The study's hypothesis that the bony anatomy of the scapula and in particular the acromion is correlated with the type of glenoid wear was confirmed. Both a more horizontal acromial orientation in the sagittal plane and increased posterior glenoid version are found in osteoarthritis of the shoulder associated with eccentric, posterior glenoid wear. Tears of the rotator cuff are significantly associated with concentric osteoarthritis of the glenoid.
与肩袖关节骨关节炎伴发或不伴发肱骨头静态后向平移相关的解剖因素尚不清楚。我们假设肩胛盂的磨损、肩胛盂倾斜角和/或肩峰前后倾斜角度与肱骨头后向平移之间存在关联。
99 例肩袖关节退变患者，涉及到肩胛盂软骨的晚期磨损和/或肩袖疾病，这些患者拟接受全肩关节置换或反肩关节置换，所有患者均接受了常规的标准肩关节 X 线和 CT 检查。所测量的指标包括肩胛盂倾斜角、肱骨头扭转、肩峰后倾角度和临界肩角。根据 Walch 等提出的分类方法对肩胛盂形状进行分类，并评估肩袖的完整性。
肩胛盂为 B2 或 C 型的患者，肩胛盂后倾的中位数增加了 4°（P = .022），肩峰后倾角度（肩峰后倾角度，61°比 56°；P = .004）更陡，肩胛盂倾斜角减去肩峰后倾角度的综合评分更高（优势比，0.93 [95%置信区间，0.89-0.97]；P < .001；截断值，-27°）。当肩袖撕裂时，与肩袖完整时相比，肩袖关节骨关节炎的改变更轻（例如，肩袖冈上肌的退变 P < .001）。
肩胛盂的骨性解剖结构，尤其是肩峰，与肩胛盂的磨损类型相关，这一研究假设得到了证实。在与偏心性、肩胛盂后向磨损相关的肩袖关节骨关节炎中，矢状位肩峰的水平位置更陡，肩胛盂后倾角度更大。肩袖撕裂与肩胛盂的同心性骨关节炎显著相关。
