Ozel Omer, Hudek Robert, Abdrabou Mohamed S, Werner Birgit S, Gohlke Frank
Department of Orthopaedics, Baskent University Istanbul Hospital, Oymacı sok, no:7 34662 Altunizade Uskudar, Istanbul, Turkey.
Department of Shoulder Surgery, Rhön Klinikum, Bad Neustadt an der Saale, Germany.
BMC Musculoskelet Disord. 2020 Oct 9;21(1):668. doi: 10.1186/s12891-020-03690-8.
The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°.
A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group.
The median (min/max) values for the 231 shoulders were 8° (- 23°/56°) for the inclination angle, - 11°(- 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders.
Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact.
Level III.
肩关节置换术（无论是反置式还是解剖型）的成功取决于纠正潜在的关节盂畸形，尤其是骨关节炎患者。我们假设，在肩关节关节炎患者中，关节盂的版本分布，尤其是倾斜度被低估了，而且通过计算机断层扫描（CT）的三维（3D）软件程序，可以在更大比例的肩袖功能不全患者中检测到关节盂上倾角，在肩袖完整的骨关节炎患者中也是如此。由于肩袖失衡对继发性关节盂磨损的影响，我们进一步分析了临界肩角（CSA）的值和肩袖的脂肪浸润情况。本研究的目的是确定：1）关节盂倾斜度和版本的分布；2）关节盂倾斜度、版本、临界肩角（CSA）与肩袖状态之间的关系；3）肩袖完整且上倾角大于10°的患者比例。
共对231个肩关节进行了X线图像、计算机断层扫描（CT）的三维（3D）软件程序和磁共振成像评估。根据倾斜角度将队列分为3组，并分为肩袖完整组和肩袖撕裂组。
231个肩关节的倾斜角中位数（最小值/最大值）为8°（-23°/56°），版本角为-11°（-55°/23°），CSA为31.5°（17.6°/61.6°）。大多数关节盂显示后上方侵蚀。与肩袖完整组相比，肩袖撕裂组的关节盂倾斜角和CSA显著更高（两者P均<0.001）。肩袖撕裂在高倾斜度组比低倾斜度组和无倾斜度组在统计学上更显著（p<0.001）。在高倾斜度组中，105个肩关节中有41个（39%）肩袖完整，约占所有肩关节的18%。
我们的研究结果表明，为了正确评估上倾角，对关节盂倾斜度进行三维评估对于肩关节置换术前规划是必不可少的，而且即使肩袖完整，反置式肩关节置换术的考虑频率可能比以前预期的更高。
三级。
