Das Abhishek Kumar, Wright Andrew C, Singh Jagwant, Monga Puneet
Wrightington Hospital, WWL NHS Foundation Trust, Hall Lane, Wigan, WN6 9EP, UK.
J Clin Orthop Trauma. 2020 Mar;11(Suppl 2):S275-S279. doi: 10.1016/j.jcot.2020.02.005. Epub 2020 Feb 14.
Walch type B2 has biconcave glenoid with posterior erosion, bone loss and humeral head subluxation. This leads to decreased glenohumeral contact area and increased contact pressure. During total shoulder arthroplasty(TSA), uncorrected retroversion causes eccentric loading and failure of glenoid component. It also leads to humeral head decentring with posterior rim loading, early glenoid wear and component loosening. This study aims to review anatomical restoration of glenoid version and humeral head centring in TSA with B2 glenoid using CT scans.
This is a retrospective review of TSA for glenohumeral osteoarthritis with B2 Glenoid morphology. All polyethylene posterior wedge augmented glenoid component was used. All patients underwent pre and post surgery CT Scans. Glenoid version was calculated using neoglenoid line and medial scapular border as reference point. Post-operative humeral head centering was calculated using offset of centre of rotation of humeral head with plane of scapula on axial CT-Scan.
Study had 10 patients with 11 TSA between June 2017 and July 2018. Mean age was 59(45-80)years. Mean preoperative retroversion was 16(13-23)degrees. This was corrected to a mean of 0° retroversion postoperatively. 63% had good radiological correction (0-5° retroversion). Humeral head was well centered post-operatively with mean humeral scapula alignment offset of 2.1(0.8-4.5) mm posteriorly. All cases had well-centered humeral head postoperatively with offset less than 5 mm.
Total shoulder replacement in B2 glenoid is technically demanding. Our radiological results show favourable outcome in terms of correction of gelenoid retroversion and eliminating posterior instability using wedge glenoid component.
IV.
Walch B2型肩胛盂呈双凹形，伴有后方侵蚀、骨质流失和肱骨头半脱位。这会导致盂肱关节接触面积减小以及接触压力增加。在全肩关节置换术（TSA）期间，未矫正的后倾会导致偏心负荷和肩胛盂假体失效。它还会导致肱骨头偏心并伴有后方边缘负荷、肩胛盂早期磨损和假体松动。本研究旨在通过CT扫描评估TSA治疗B2型肩胛盂时肩胛盂后倾的解剖学恢复情况及肱骨头对中情况。
这是一项对患有B2型肩胛盂形态的盂肱关节骨关节炎进行TSA的回顾性研究。所有病例均使用了聚乙烯后楔形增强肩胛盂假体。所有患者均接受了术前和术后CT扫描。肩胛盂后倾角度通过以新肩胛盂线和肩胛内侧缘为参考点进行计算。术后肱骨头对中情况通过在轴向CT扫描上测量肱骨头旋转中心与肩胛平面的偏移来计算。
本研究纳入了2017年6月至2018年7月期间的10例患者，共进行了11次TSA手术。平均年龄为59岁（45 - 80岁）。术前平均后倾角度为16°（13 - 23°）。术后平均后倾角度矫正至0°。63%的患者获得了良好的影像学矫正（后倾0 - 5°）。术后肱骨头对中良好，肱骨头与肩胛的平均对线偏移为后方2.1毫米（0.8 - 4.5毫米）。所有病例术后肱骨头对中均良好，偏移小于5毫米。
B2型肩胛盂的全肩关节置换术技术要求较高。我们的影像学结果显示，使用楔形肩胛盂假体在矫正肩胛盂后倾和消除后方不稳定方面取得了良好的效果。
IV级
