Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
Sci Rep. 2022 Dec 5;12(1):21011. doi: 10.1038/s41598-022-25173-7.
Reverse total shoulder arthroplasty (RTSA) improves function and reduces pain for patients with complex shoulder problems. However, there is a lack of literature regarding the association of radiographic parameters on clinical outcomes after RTSA. The aim of this study was to analyze various radiographic parameters that may be predictive of clinical outcomes after RTSA. A total of 55 patients treated with RTSA were enrolled. Shoulder radiographic parameters were used for measurement of critical shoulder angle, acromial index, acromiohumeral interval, deltoid lever arm, acromial angulation, glenoid version, and acromial height. Preoperative and postoperative clinical outcomes were evaluated at a minimum 2-year follow-up. An analysis of correlations between radiographic parameters and clinical outcomes was then performed. A significant change in critical shoulder angle, acromiohumeral interval, and deltoid lever arm was observed between preoperative and postoperative radiographic measurements. A significant improvement was observed in all clinical outcomes and range of motions from preoperative to postoperative (all p < 0.001). A negative correlation of postoperative acromiohumeral interval with forward flexion (r = - 0.270; p = 0.046), external rotation (r = - 0.421; p = 0.001), and internal rotation (r = 0.275; p = 0.042) was observed at final follow-up. In addition, postoperative acromiohumeral interval less than 29 mm had an 86% positive predictive value of obtaining 130° of forward flexion and 45° of external rotation. It was found that postoperative acromiohumeral interval showed an association with active range of motion in patients who underwent RTSA. In particular, excessive distalization reduced forward flexion and external rotation motion of the shoulder in patients treated with RTSA.
反向全肩关节置换术（RTSA）可改善复杂肩部问题患者的功能并减轻疼痛。然而，关于 RTSA 后放射影像学参数与临床结果之间的关联，文献报道较少。本研究旨在分析 RTSA 后可能与临床结果相关的各种放射影像学参数。共纳入 55 例行 RTSA 治疗的患者。使用肩部放射影像学参数测量关键肩部角度、肩峰指数、肩峰肱骨关节间隙、三角肌杠杆臂、肩峰倾斜角、肩胛盂倾斜度和肩峰高度。在至少 2 年的随访中，评估术前和术后的临床结果。然后分析放射影像学参数与临床结果之间的相关性。与术前放射影像学测量相比，术后关键肩部角度、肩峰肱骨关节间隙和三角肌杠杆臂有明显变化。所有临床结果和运动范围均从术前到术后显著改善（均 P < 0.001）。术后肩峰肱骨关节间隙与前屈（r = -0.270；P = 0.046）、外旋（r = -0.421；P = 0.001）和内旋（r = -0.275；P = 0.042）在最终随访时呈负相关。此外，术后肩峰肱骨关节间隙小于 29mm 时，获得 130°前屈和 45°外旋的阳性预测值为 86%。研究发现，RTSA 术后肩峰肱骨关节间隙与患者主动运动范围相关。特别是，过度远移会降低 RTSA 治疗患者的前屈和外旋运动。
