Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2020 Jun;12(2):224-231. doi: 10.4055/cios19088. Epub 2020 May 14.
Shoulder arthroplasty is technically demanding and relies heavily on the precision of surgical techniques. Proper glenoid component sizing plays a crucial role in successful shoulder arthroplasty. We measured the size and penetrative depth of the glenoid for peg or screw fixation in nonarthritic and degenerative arthritic shoulders by using three-dimensional computed tomography to determine the reference dimensions of the glenoid in nonarthritic and degenerative arthritic shoulders.
From January 2010 to January 2011, data on two groups of patients were collected and reviewed. Group 1 comprised 38 patients who underwent surgical treatment due to fracture of the proximal humerus and who had no evidence of a pathological glenoid. Group 2 comprised 14 patients who underwent surgical treatment due to osteoarthritis of the glenohumeral joint. The height (maximal superoinferior diameter) of the glenoid was measured, and the width (anteroposterior [AP] diameter) of the glenoid was measured at five different levels (H1-H5). Axial images were taken at H1-H5 levels, the AP glenoid diameter of each was divided into eight areas, and division points were labeled as W1-W7. The penetrative depths between the near cortex and far cortex of the glenoid (thickness) at each point (W1-W7) were measured.
The overall mean glenoid height was 37.67 ± 4.09 mm in nonarthritic glenoids and 39.42 ± 3.54 mm in degenerative arthritic glenoids. The nonarthritic glenoid was significantly thicker than the degenerative arthritic glenoid at the H1W3, H1W4, H1W5, H2W7, H3W1, H3W6, H3W7, H4W5, H4W6, H4W7, H5W4, H5W5, H5W6, and H5W7 points. The posteroinferior quadrant had the smallest penetrative depth in both nonarthritic and degenerative arthritic glenoids. Also, the degenerative arthritic glenoids were significantly thinner than the nonarthritic glenoids along the posterior and inferior parts of the glenoid.
The posterior and inferior parts of the degenerative arthritic glenoid appears thinner than the nonarthritic glenoid. Thus, caution has to be taken when drilling the screw hole or inserting screws into the posteroinferior parts, where the glenoid is thinner than 15 mm on average, to avoid penetration of the far cortex.
肩关节置换术技术要求高，对手术技术的精度要求很高。正确的盂肱关节组件尺寸对于成功的肩关节置换术至关重要。我们通过三维计算机断层扫描测量非关节炎和退行性关节炎肩的 peg 或螺钉固定的盂肱关节的大小和穿透深度，以确定非关节炎和退行性关节炎肩的盂肱关节的参考尺寸。
2010 年 1 月至 2011 年 1 月，收集并回顾了两组患者的数据。第 1 组包括 38 例因肱骨近端骨折而接受手术治疗且无病理性盂肱关节的患者。第 2 组包括 14 例因肩肱关节骨关节炎而接受手术治疗的患者。测量盂肱关节的高度（最大上下径），并在五个不同水平（H1-H5）测量盂肱关节的宽度（前后径）。在 H1-H5 水平拍摄轴向图像，将每个盂肱关节的前后径分为八个区域，并标记分界点为 W1-W7。测量每个点（W1-W7）处盂肱关节近皮质和远皮质之间的穿透深度（厚度）。
非关节炎盂肱关节的总体平均盂肱关节高度为 37.67 ± 4.09mm，退行性关节炎盂肱关节的平均高度为 39.42 ± 3.54mm。非关节炎盂肱关节在 H1W3、H1W4、H1W5、H2W7、H3W1、H3W6、H3W7、H4W5、H4W6、H4W7、H5W4、H5W5、H5W6 和 H5W7 点明显比退行性关节炎盂肱关节厚。非关节炎和退行性关节炎盂肱关节的后下象限穿透深度最小。此外，退行性关节炎盂肱关节的后下部分明显比非关节炎盂肱关节薄。
退行性关节炎盂肱关节的后下部分看起来比非关节炎盂肱关节薄。因此，在钻入螺钉孔或向平均厚度小于 15mm 的盂肱关节后下部分插入螺钉时，需要谨慎操作，以避免穿透远皮质。
