Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany.
J Shoulder Elbow Surg. 2021 Apr;30(4):756-762. doi: 10.1016/j.jse.2020.08.004. Epub 2020 Aug 24.
Static posterior subluxation of the humeral head is a pre-osteoarthritic deformity preceding posterior erosion in young patients. Its etiology remains unknown. The aim of this study was to analyze the differences in scapular morphology between young patients with pre-osteoarthritic static posterior subluxation of the humeral head and healthy controls with a centered humeral head.
We performed a retrospective analysis of all patients with pre-osteoarthritic static posterior subluxation of the humeral head who were treated in our institution between January 2018 and November 2019. Fourteen shoulders in 12 patients were included in this study and then matched according their age, sex, and affected side with controls. Computed tomography images of both groups were compared in the standardized axial imaging plane for differences in scapular morphology. The following parameters were measured: glenoid version relative to the Friedman line and scapular blade axis, scapulohumeral and glenohumeral subluxation index, and neck angle, as well as glenoid and humeral offset.
The patients in the subluxation group showed significantly higher scapulohumeral and glenohumeral subluxation indexes than controls (0.76 vs. 0.55 [P < .0001] and 0.58 vs. 0.51 [P = .016], respectively). The mean measurements of glenoid version according to the Friedman line and relative to the scapular blade axis were significantly higher in the subluxation group than in controls (19° vs. 4° [P < .0001]and 14° vs. 2° [P = .0002], respectively). The glenoid vault was significantly more anteriorly positioned with respect to the scapular blade axis in the subluxation group than in controls (neck angle, 166° vs. 173° [P = .0003]; glenoid offset, 9.2 mm vs. 4.6 mm [P = .0005]). The midpoint of the humeral head showed a posterior offset with respect to the scapular blade axis in the subluxation group, whereas controls had an anteriorly placed midpoint of the humeral head (-2 mm vs. 3.1 mm, P = .01). A higher scapulohumeral subluxation index showed significant correlations with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.493, P = .008 and decreased neck angle: r = -0.554, P = .002), a posterior humeral offset (r = -0.775, P < .0001), and excessive glenoid retroversion measured by both methods (Friedman line: r = 0.852, P < .0001; scapular blade axis: r = 0.803, P < .0001). A higher glenohumeral subluxation index also correlated significantly with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.403, P = .034; decreased neck angle: r = -0.406, P = .032) and posterior humeral offset (r = -0.502, P = .006).
Young patients with pre-osteoarthritic static posterior subluxation of the humeral head have significant constitutional differences in scapular morphology in terms of an increased anterior glenoid offset, excessive glenoid retroversion, and increased posterior humeral offset in relation to the scapular blade compared with healthy matched controls.
静态肩峰下后脱位是年轻患者发生骨关节炎前的一种畸形，先于肱骨头后向侵蚀。其病因尚不清楚。本研究的目的是分析年轻患者的肩胛形态学差异在骨关节炎前静态肩峰下后脱位的肱骨头与中心肱骨头的健康对照组。
我们对 2018 年 1 月至 2019 年 11 月在我院治疗的所有骨关节炎前静态肩峰下后脱位患者进行了回顾性分析。12 名患者的 14 个肩部纳入本研究，并根据年龄、性别和受累侧与对照组进行匹配。比较两组患者在标准化轴位成像平面上的肩胛形态学差异。测量以下参数：相对于 Friedman 线和肩胛骨轴的肩胛骨版本、肩胛盂肱关节和盂肱关节半脱位指数以及颈角，以及肩胛盂和肱骨头偏移。
脱位组患者的肩胛盂肱关节和盂肱关节半脱位指数明显高于对照组（0.76 比 0.55 [P <.0001]和 0.58 比 0.51 [P =.016]）。脱位组的 Friedman 线和肩胛骨轴测量的肩胛骨版本平均值明显高于对照组（19°比 4°[P <.0001]和 14°比 2°[P =.0002]）。与对照组相比，肩胛骨轴的肩胛骨穹顶向前移位（颈角，166°比 173°[P =.0003]；肩胛骨偏移，9.2 毫米比 4.6 毫米[P =.0005]）。与对照组相比，肩胛骨轴的肱骨头中点向后偏移（肱骨头中点向后偏移：-2 毫米比 3.1 毫米，P =.01）。较高的肩胛盂肱关节半脱位指数与肩胛骨穹顶的前向偏移显著相关（增加的肩胛骨偏移：r = 0.493，P =.008 和减少的颈角：r = -0.554，P =.002），肱骨头向后偏移（r = -0.775，P <.0001），以及两种方法测量的肩胛骨过度后旋（Friedman 线：r = 0.852，P <.0001；肩胛骨轴：r = 0.803，P <.0001）。较高的盂肱关节半脱位指数也与肩胛骨穹顶的前向偏移显著相关（增加的肩胛骨偏移：r = 0.403，P =.034；减少的颈角：r = -0.406，P =.032）和肱骨头向后偏移（r = -0.502，P =.006）。
与健康匹配的对照组相比，骨关节炎前静态肩峰下后脱位的年轻患者的肩胛形态学存在明显的固有差异，主要表现为肩胛骨穹顶的前向偏移增加、肩胛骨过度后旋以及与肩胛骨轴相比肱骨头的后向偏移增加。
