Thiesen Darius M, Ernst Marielle, Meyer Jennifer, Spiro Alexander S, Yamamura Jin, Klatte Till O
Department of Trauma, Hand, and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Paediatric Orthopaedics, Children's Hospital Altona, University Medical Centre Hamburg, Bleickenallee 38, 22763, Hamburg, Germany.
Arch Orthop Trauma Surg. 2019 Feb;139(2):181-187. doi: 10.1007/s00402-018-3054-2. Epub 2018 Oct 26.
The number of patients above 40 years suffering an anterior shoulder dislocation for the first time has recently increased. This study investigated the role of glenoid version, inclination and rotator interval dimension in patients older than 40 years with an anterior shoulder dislocation. We hypothesize that the rotator interval plays a more important role than the osseus alignment in older patients.
Patients aged older than 40 years with a traumatic shoulder dislocation were compared with patients who had undergone magnetic resonance imaging (MRI) for a different reason. The MRIs of 61 dislocation group patients were compared with MRIs of 73 comparison group patients. Two shoulder surgeons measured glenoid version, inclination, height and width, rotator interval (RI) height, base (width) and area. The study and comparison group consisted of 61 patients with a mean age of 59 ± 9 years and 73 patients with a mean age of 57 ± 12, respectively.
The mean glenoid version of the dislocation group was - 4.9° ± 4.4° (retroversion) and mean inclination was 9.8° ± 8° (reclination). Mean rotator interval base, height and the rotator interval area was 46 ± 6 mm, 14 ± 5 mm and 33 ± 14 mm, respectively. The comparison group had a mean glenoid version of - 5.4° ± 5.4° and a mean inclination of 10.8° ± 6.2°. The rotator interval base was 41 ± 6 mm, the height was 16 ± 4 mm and the area was 34 ± 11 mm. The between-group differences were statistically significant for rotator interval height and base (p < 0.0001). A significant difference was revealed for the height-width ratio of the glenoid (p = 0.0001).
In patients older than 40 years who have suffered anterior shoulder dislocation, the shape of the glenoid rather than its spatial position is of significance. A wide and high rotator interval promotes anterior shoulder dislocation in these patients.
近期，40岁以上首次发生肩关节前脱位的患者数量有所增加。本研究调查了肩胛盂形态、倾斜度和旋转间隙尺寸在40岁以上肩关节前脱位患者中的作用。我们假设在老年患者中，旋转间隙比骨骼对线起着更重要的作用。
将40岁以上创伤性肩关节脱位患者与因其他原因接受磁共振成像（MRI）检查的患者进行比较。将61例脱位组患者的MRI与73例对照组患者的MRI进行比较。两位肩关节外科医生测量了肩胛盂形态、倾斜度、高度和宽度、旋转间隙（RI）高度、底部（宽度）和面积。研究组和对照组分别由61例平均年龄为59±9岁的患者和73例平均年龄为57±12岁的患者组成。
脱位组肩胛盂平均形态为-4.9°±4.4°（后倾），平均倾斜度为9.8°±8°（后倾）。旋转间隙底部、高度和旋转间隙面积的平均值分别为46±6mm、14±5mm和33±14mm。对照组肩胛盂平均形态为-5.4°±5.4°，平均倾斜度为10.8°±6.2°。旋转间隙底部为41±6mm，高度为16±4mm，面积为34±11mm。旋转间隙高度和底部的组间差异具有统计学意义（p<0.0001）。肩胛盂的高宽比存在显著差异（p=0.0001）。
在40岁以上发生肩关节前脱位的患者中，肩胛盂的形状而非其空间位置具有重要意义。宽且高的旋转间隙会促使这些患者发生肩关节前脱位。
