Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(2):2309499020921979. doi: 10.1177/2309499020921979.
In vivo three-dimensional (3D) kinematics of the scapula after reverse total shoulder arthroplasty (rTSA) have been sparsely investigated. The aim of this study was to analyze static and dynamic kinematic alterations of the scapula after rTSA in vivo with the use of computer-aided 3D reconstruction program.
A total of 15 patients with cuff tear arthropathy treated by rTSA participated. Scapulae with rTSA and the contralateral scapulae were evaluated with computed tomography scan data in 0° and 120° forward flexion positions of the glenohumeral joint. To examine static scapular kinematic alterations, the angular position and distance from the thorax were evaluated in the shoulder neutral position. 3D rotational and translational movements of the scapula in relation to the thorax were also measured during arm elevation to evaluate dynamic scapular kinematic alterations.
Scapulae with rTSA were more anteriorly tilted in the sagittal plane and more internally rotated in the axial plane than were the contralateral scapulae. However, no significant differences were observed in the upward rotated position in the coronal plane or in the distance from the thorax in any plane between the scapulae with rTSA and the contralateral scapulae. In dynamic analyses, upward rotational movement in the coronal plane, external rotation in the axial plane, and posterior tilting in the sagittal plane showed significant differences between the scapulae with rTSA and the contralateral scapulae during elevation. In contrast, translational movements in coordination revealed no statistical differences between the two scapular groups except for lateral translation.
Data from the 3D reconstruction program showed that rTSA might result in static positional changes and dynamic movement alterations.
Therapeutic, IV.
反向全肩关节置换术（rTSA）后肩胛骨的体内三维（3D）运动学研究甚少。本研究旨在使用计算机辅助 3D 重建程序分析 rTSA 后肩胛骨的静态和动态运动变化。
共纳入 15 例肩袖撕裂性关节炎行 rTSA 治疗的患者。对 rTSA 后的肩胛骨和对侧肩胛骨进行计算机断层扫描（CT）扫描数据评估，在肩关节 0°和 120°前屈位。为了评估静态肩胛骨运动变化，在肩部中立位评估肩胛骨的角度位置和与胸廓的距离。还测量了肩胛骨在肩关节外展时相对于胸廓的 3D 旋转和平移运动，以评估动态肩胛骨运动变化。
与对侧肩胛骨相比，rTSA 后的肩胛骨在矢状面更向前倾斜，在轴向更向内旋转。然而，在冠状面的向上旋转位置或任何平面的与胸廓的距离方面，rTSA 后的肩胛骨与对侧肩胛骨之间没有观察到显著差异。在动态分析中，冠状面的向上旋转运动、轴向的外旋运动和矢状面的后倾在肩胛骨外展时在 rTSA 后的肩胛骨和对侧肩胛骨之间存在显著差异。相比之下，除了横向平移外，平移运动的协调没有显示出两组肩胛骨之间的统计学差异。
3D 重建程序的数据表明，rTSA 可能导致静态位置变化和动态运动改变。
治疗性，IV。
