Dainotto Tamara, Gómez Diego, Ernst Glenda
Departamento deOrtopedia e Traumatologia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Conselho Científico, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Rev Bras Ortop (Sao Paulo). 2024 Mar 21;59(1):e93-e100. doi: 10.1055/s-0044-1779609. eCollection 2024 Feb.
To evaluate the influence of radiographic values on clinical and functional results in patients treated with reverse arthroplasty for rotator cuff arthropathy (RCA) using a lateralized design. A retrospective analysis was performed. Patient demographics were recorded, as well as preoperative and postoperative range of motion. Function was calculated using the Constant-Murley score both before and after the procedure. Pre and postoperative anteroposterior and axial radiographs of the affected shoulder were analysed. In the preoperative images, the following was calculated: acromiohumeral distance (AHD) and lateral humeral offset (LHO). Postoperative measurements included: AHD, LHO, distalization shoulder angle (DSA) and lateralisation shoulder angle (LSA). Linear regression and quadratic regression analysis was performed to determine their degree of association with final functional outcomes. By applying a quadratic regression analysis and ROC curves, the cut-off values were determined with respect to the above-mentioned angles and the positive predictive value was calculated. The greater anterior elevation (AE) ranges were found with DSA between 40-45° and LSA among 80°- 90°, while better ABD was observed with LSA of 90-100°. Preoperative AHD was correlated to RE (r :0.47; p:0.049). Postoperative AHD was found to be in a directly proportional relationship with AE (r :0.49; p:0.03). Postoperative ABD showed an inverse linear regression with preoperative AHD (r : -0.44, p:0.047). LSA and DSA were inversely related. We found that a DSA between 40-45° and a LSA of 80-100° could lead to better range of motion regarding AE and ABD in patients with rotator cuff arthropathy treated with RSA.
为了评估采用外侧化设计的反肩关节置换术治疗肩袖关节病（RCA）患者时，影像学参数对临床和功能结果的影响。
进行了一项回顾性分析。记录患者人口统计学资料以及术前和术后的活动范围。使用Constant-Murley评分在手术前后计算功能情况。分析患侧肩部术前和术后的前后位及轴位X线片。在术前图像上，计算以下参数：肩峰肱骨距离（AHD）和肱骨外侧偏移（LHO）。术后测量参数包括：AHD、LHO、肩关节远侧化角度（DSA）和肩关节外侧化角度（LSA）。进行线性回归和二次回归分析以确定它们与最终功能结果的关联程度。通过应用二次回归分析和ROC曲线，确定上述角度的临界值并计算阳性预测值。
发现当DSA在40 - 45°之间且LSA在80° - 90°之间时，前屈上举（AE）范围更大，而当LSA为90 - 100°时，外展（ABD）情况更佳。术前AHD与后伸（RE）相关（r = 0.47；p = 0.049）。发现术后AHD与AE呈正比关系（r = 0.49；p = 0.03）。术后ABD与术前AHD呈负线性回归关系（r = -0.44，p = 0.047）。LSA和DSA呈负相关。
我们发现，对于接受反肩关节置换术治疗的肩袖关节病患者，DSA在40 - 45°之间且LSA在80 - 100°之间可使AE和ABD的活动范围更佳。
