Inoue Jumpei, Takenaga Tetsuya, Tsuchiya Atsushi, Okubo Norio, Takeuchi Satoshi, Takaba Keishi, Nozaki Masahiro, Kobayashi Makoto, Fukushima Hiroaki, Kato Jiro, Murakami Hideki, Yoshida Masahito
Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan.
Orthop J Sports Med. 2022 Jul 8;10(7):23259671221101924. doi: 10.1177/23259671221101924. eCollection 2022 Jul.
Ultrasonography can be used to quantitatively assess anterior humeral head translation (AHHT) at different degrees of shoulder abduction. Risk factors for recurrent shoulder instability have been identified.
It was hypothesized that the number of dislocations or glenoid or humeral bone loss would be associated with more AHHT as measured using ultrasound.
Cross-sectional study; Level of evidence, 3.
A total of 39 patients who underwent surgery for anterior shoulder instability were prospectively studied. Ultrasound assessment of AHHT was performed immediately after general anesthesia was induced. The upper arm was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was applied to the proximal third of the arm. The distance from the posterior edge of the glenoid to that of the humeral head was measured at each abduction angle using ultrasound with and without a 40-N anterior force, and the AHHT was calculated. The differences in translation at each shoulder angle were compared. Additionally, the authors investigated the association between AHHT and demographic, radiographic, and clinical data.
Compared with the AHHT at 0° of abduction (5.29 mm), translation was significantly larger at 45° of abduction (8.90 mm; < .01) and 90° of abduction (9.46 mm; < .01). The mean translation was significantly larger in female patients than in male patients at all degrees of abduction ( ≤ .036 for all). There was no correlation between AHHT at any abduction angle and number of dislocations, clinical data, or radiographic data (including bone loss).
Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90° than at 0° of abduction. Anterior glenohumeral laxity was greater in female than male patients. Glenoid or humeral bone loss did not correlate with AHHT, thereby clarifying that bone loss has no direct effect on measurements of capsular laxity in neutral rotation.
超声检查可用于定量评估不同肩关节外展角度下的肱骨头前向移位（AHHT）。复发性肩关节不稳的危险因素已被确定。
假设脱位次数、关节盂或肱骨头骨质丢失与超声测量的更多AHHT相关。
横断面研究；证据等级，3级。
前瞻性研究了39例接受肩关节前向不稳手术的患者。全身麻醉诱导后立即进行AHHT的超声评估。将上臂置于外展0°、45°和90°，并对上臂近端三分之一施加40N的前向力。在每个外展角度，使用超声在施加和不施加40N前向力的情况下测量关节盂后缘与肱骨头后缘之间的距离，并计算AHHT。比较每个肩关节角度的移位差异。此外，作者研究了AHHT与人口统计学、影像学和临床数据之间的关联。
与外展0°时的AHHT（5.29mm）相比，外展45°时（8.90mm；P<0.01）和外展90°时（9.46mm；P<0.01）的移位明显更大。在所有外展角度，女性患者的平均移位均明显大于男性患者（所有P≤0.036）。任何外展角度下的AHHT与脱位次数、临床数据或影像学数据（包括骨质丢失）之间均无相关性。
超声评估AHHT显示，外展45°和90°时的松弛程度大于外展0°时。女性患者的肩肱前向松弛程度大于男性患者。关节盂或肱骨头骨质丢失与AHHT无关，从而明确骨质丢失对中立旋转时关节囊松弛度的测量没有直接影响。
