Lovse Lisa J, Culliton Kathryn, Pollock J W, Derome Pascale, Louati Hakim, Lapner Peter
Division of Orthopaedics, University of Ottawa, Ottawa, Ontario, Canada.
Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
JSES Int. 2020 Apr 8;4(2):377-381. doi: 10.1016/j.jseint.2020.01.008. eCollection 2020 Jun.
The deltopectoral approach is commonly used in shoulder arthroplasty. Various soft tissue releases can be performed to obtain adequate glenoid exposure, but their effectiveness is not known. The purpose of this study was to (1) quantify the effects of various releases on the amount of glenoid surface area exposure and (2) determine if common soft tissue releases performed about the shoulder significantly improve exposure of the glenoid.
A standard deltopectoral approach was used on cadaveric shoulders (n=8) in the beach chair position. The releases performed were as follows: long head of biceps, pectoralis major tendon, inferior capsule, and posterior capsule. Following each release, a custom-designed jig was used to mark the exposed glenoid surface. The glenoid was then digitized using a 3D surface scanner to quantify the exposed surface area with each release.
The mean glenoid surface area exposure prior to any releases was 57% (SD 8%). Following release of the long head of biceps, exposure increased to 69% (SD 10%). The exposed area was increased to 83% (SD 6%) with release of the pectoralis major, and 93% (SD 2%) with inferior capsule. The entire glenoid was exposed following posterior capsule release.
Release of the long head of biceps, pectoralis major, and inferior and posterior capsule all independently led to significant increases in glenoid surface exposure in the deltopectoral approach. Mean surface area exposed with all 3 releases was 93%. Although posterior capsular release improved exposure, the results of this study suggest that this is rarely necessary.
三角肌胸大肌入路常用于肩关节置换术。可进行多种软组织松解以获得足够的肩胛盂暴露，但它们的有效性尚不清楚。本研究的目的是：（1）量化各种松解对肩胛盂表面积暴露量的影响；（2）确定在肩部进行的常见软组织松解是否能显著改善肩胛盂的暴露。
在沙滩椅位对8具尸体肩部采用标准的三角肌胸大肌入路。进行的松解如下：肱二头肌长头、胸大肌腱、下关节囊和后关节囊。每次松解后，使用定制夹具标记暴露的肩胛盂表面。然后使用三维表面扫描仪对肩胛盂进行数字化处理，以量化每次松解后的暴露表面积。
在进行任何松解之前，肩胛盂的平均表面积暴露为57%（标准差8%）。肱二头肌长头松解后，暴露增加到69%（标准差10%）。胸大肌松解后，暴露面积增加到83%（标准差6%），下关节囊松解后为93%（标准差2%）。后关节囊松解后肩胛盂完全暴露。
在三角肌胸大肌入路中，肱二头肌长头、胸大肌以及下关节囊和后关节囊的松解均独立导致肩胛盂表面暴露显著增加。所有三种松解后的平均暴露表面积为93%。虽然后关节囊松解改善了暴露，但本研究结果表明这很少有必要。
