Baek Md Chang Hee, Kim Md Jung Gon, Lee Md Dong Hyeon, Baek Gyu Rim
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
Yeosu Baek Hospital.
J Shoulder Elb Arthroplast. 2021 Jun 14;5:24715492211022171. doi: 10.1177/24715492211022171. eCollection 2021.
Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor.
The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared.
Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008).
In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.
肩峰病变（AP），如肩峰应力反应（ASR）、肩峰应力隐匿性骨折（ASOF）和肩峰应力骨折（ASF），是已知的会降低全肩关节置换术（RSA）后临床评分和患者满意度的并发症。有报道称，一些增加肩峰应力的因素是AP的危险因素，但这一点也尚不清楚。喙肩韧带（CAL）是一种可分散肩峰上应力负荷的结构，尽管其重要性已被提及，但相关研究仍很缺乏。因此，我们根据CAL的保留情况调查了AP的发生率，以及它是否为一个危险因素。
本研究对2016年至2018年接受RSA手术的患者进行了回顾性分析。CAL横断的患者被分为第1组，CAL保留的患者被分为第2组。通过症状和超声识别ASR和ASOF，通过简单X线片或计算机断层扫描识别ASF。检查并比较每组中AP的发生率。
在总共265例患者中。第1组197例中，ASR 21例（10.7%），ASOF 28例（14.2%），ASF 10例（5.1%），AP总计59例（29.4%）。第2组68例中，ASR 2例（2.9%），ASOF 6例（8.8%），ASF 1例（1.5%），AP总计9例（13.2%）。证实保留CAL的组中ASR和ASOP显著降低。（P = 0.008）。
在手术中保留CAL的情况下，证实ASR、ASOF的发生率降低。因此，保留CAL可被视为一个可改变的危险因素，通过分散RSA手术后施加在肩峰上的应力来降低AP的风险。
