Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.
Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.
Skeletal Radiol. 2021 May;50(5):881-894. doi: 10.1007/s00256-020-03647-x. Epub 2020 Oct 23.
Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon.
肩关节置换术的应用日益增多，而骨关节炎是该手术最常见的适应证。然而，关节盂侧被广泛认为是肩关节置换长期耐用性的限制因素，骨关节炎导致关节盂的特征性骨改变，通过减少已经有限的关节盂骨量、改变生物力学以及干扰手术显露，从而加剧这一挑战。本文回顾了关节盂形态的 Walch 分类系统。讨论了骨关节炎在关节盂上的几种典型表现，包括中央骨丢失、后方骨丢失、后倾、双凹面、倾斜、骨赘形成、软骨下骨质量和骨密度。还回顾了三种主要的肩关节置换类型，以及几种处理关节盂畸形的技术，包括偏心扩孔、植骨和使用增强型关节盂组件。最终，肩关节置换的主要目标是在保留骨量的同时纠正关节盂畸形，这主要取决于术前影像学对关节盂的特征化。了解手术技术和关节盂形态对手术决策的影响，使放射科医生能够提供外科医生所需的形态学信息。
