Góralczyk Adrian, Akgün Doruk, Siegert Paul, Pawelke Jonas, Hermanowicz Krzysztof, Flury Matthias, Simmen Beat R, Scheibel Markus, Moroder Philipp
Department of Orthopaedics, Humana Medica Omeda Hospital, Białystok, Poland.
Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany.
J Shoulder Elbow Surg. 2025 Mar;34(3):e158-e164. doi: 10.1016/j.jse.2024.06.021. Epub 2024 Aug 10.
Weber rotational osteotomy that increases humeral retrotorsion in patients with anterior shoulder instability has become unpopular because of recurrence of instability and high rates of early-onset osteoarthritis (OA). However, the wear pattern in patients after rotational osteotomy remains unknown. The aim of this study was to determine the influence of surgically increased humerus retrotorsion on glenohumeral and scapulohumeral centering in a long-term follow-up.
The data of 18 shoulders in 18 patients diagnosed with a unilateral chronic recurrent anterior shoulder instability treated with an internal rotation subcapital humerus osteotomy between 1984 and 1990 were drawn from a previously published cohort and enrolled in the study. All patients had available bilateral computed tomography (CT) scans performed after a mean follow-up of 14 (12-18) years. On these CT scans a comparison of the operated and the contralateral healthy side with regard to humerus torsion, glenoid version, glenoid offset, glenohumeral and scapulohumeral subluxation indices, rotator cuff action lines, and osteoarthritic changes was performed.
The analysis of follow-up CT scans revealed a significantly higher mean humeral retrotorsion in the operated side compared with the healthy side (41.6° ± 14.0° vs. 20.7° ± 8.2°, P < .001). No differences were found in terms of glenohumeral subluxation index (0.50 ± 0.08 vs. 0.51 ± 0.03, P = .259), scapulohumeral subluxation index (0.53 ± 0.09 vs. 0.54 ± 0.03, P = .283), glenoid version (-3.9° ± 4.6° vs. -4.1° ± 3.7°, P = .424), glenoid offset (4.0 ± 2.8 mm vs. 4.0 ± 1.3 mm, P = .484), infraspinatus action lines (102.5° ± 4.7° vs. 101.2° ± 2.1°, P = .116), subscapularis action lines (74.0° ± 6.0° vs. 73.1° ± 2.3°, P = .260), and resultant rotator cuff action lines (87.8° ± 4.9° vs. 87.0° ± 1.8°, P = .231) between operated and healthy shoulders. Osteoarthritic changes were observed in all operated shoulders and in 13 of 18 healthy shoulders. The OA grade was mild in 5 patients, moderate in 11, and severe in 2 cases for operated shoulders and mild in 13 healthy shoulders at the last follow-up.
The surgical increase of humeral retrotorsion by 20°-30° did not affect glenohumeral and scapulohumeral centering in patients with a Weber rotational osteotomy after a long-term follow-up compared to the healthy side. Although a high degree of early-onset OA was observed it remains unclear whether the cause is the surgical interventions performed or the joint instability itself.
对于存在前肩不稳的患者，Weber旋转截骨术可增加肱骨后旋，但由于不稳复发和早期骨关节炎（OA）发生率高，该术式已不再常用。然而，旋转截骨术后患者的磨损模式仍不清楚。本研究的目的是通过长期随访确定手术增加肱骨后旋对盂肱和肩胛肱对中的影响。
从先前发表的队列中选取1984年至1990年间接受肱骨内旋下截骨术治疗的18例单侧慢性复发性前肩不稳患者的18个肩部的数据，并纳入本研究。所有患者在平均随访14（12 - 18）年后均有可用的双侧计算机断层扫描（CT）。在这些CT扫描上，对手术侧和对侧健康侧的肱骨扭转、盂肱关节面倾斜度、盂肱关节偏移、盂肱和肩胛肱半脱位指数、肩袖作用线以及骨关节炎变化进行了比较。
随访CT扫描分析显示，手术侧的平均肱骨后旋明显高于健康侧（41.6°±14.0°对20.7°±8.2°，P <.001）。在盂肱半脱位指数（0.50±0.08对0.51±0.03，P =.259）、肩胛肱半脱位指数（0.53±0.09对0.54±0.03，P =.283）、盂肱关节面倾斜度（-3.9°±4.6°对-4.1°±3.7°，P =.424）、盂肱关节偏移（4.0±2.8mm对4.0±1.3mm，P =.484）、冈下肌作用线（102.5°±4.7°对101.2°±2.1°，P =.116）、肩胛下肌作用线（74.0°±6.0°对73.1°±2.3°，P =.260）以及肩袖合力作用线（87.8°±4.9°对87.0°±1.8°，P =.231）方面，手术侧和健康侧之间未发现差异。在所有手术侧肩部以及18例健康侧肩部中的13例观察到了骨关节炎变化。在最后一次随访时，手术侧肩部5例患者为轻度OA，11例为中度，2例为重度；健康侧肩部13例为轻度OA。
与健康侧相比，长期随访后，Weber旋转截骨术患者通过手术使肱骨后旋增加20° - 30°并未影响盂肱和肩胛肱对中。尽管观察到高度的早期OA，但尚不清楚其原因是手术干预还是关节不稳本身。
