Kawamata Jun, Fukuta Shoji, Nakai Daisuke, Kano Masashi, Tezuka Fumitake, Wada Keizo, Sairyo Koichi
Department of Orthopedics, Tokushima University, Tokushima, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Kochi National Hospital, Kochi, Japan.
JSES Rev Rep Tech. 2024 Mar 20;4(3):398-405. doi: 10.1016/j.xrrt.2024.02.009. eCollection 2024 Aug.
Both scapular dynamics and static scapular position are important in the treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately.
Using four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades.
SPAPs associated with GAT were sagittal vertical axis (R = 0.14, = .011), TK (R = 0.12, = .026), and LL (R = -0.11, = .046). Multivariate analysis identified TK and LL as independent influencing factors (TK, = .001; LL, = .008). SPAPs associated with GAVA were CL (R = 0.17, = .002), TK (R = 0.29, < .001), and LL (R = 0.25, < .001). Multivariate analysis identified CL, TK, and LL as independent influencing factors (CL, = .01; TK, = .03; LL, = .03). There were 183, 127, and 19 cases categorized as grades 1, 2, and 3. GAT (grade 1, 24.0 ± 7.8; 2, 32.4 ± 7.0; 3, 41.0 ± 7.8), GAVA (1, 29.3 ± 7.6; 2, 33.7 ± 9.5; 3, 31.5 ± 8.3), and TK (1, 30.6 ± 13.6; 2, 35.1 ± 14.2; 3, 43.1 ± 20.4) differed significantly according to grade.
We identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs.
肩胛动力学和静态肩胛位置在肩部功能障碍的治疗中都很重要。本研究旨在创建一个能够在X线平片上评估肩胛位置，并准确评估肩胛位置与姿势之间关系的指标。
我们使用4具新鲜冷冻尸体，根据喙突拐点阴影与肩胛骨上缘在正位X线平片上的重叠程度制定了一个关节盂角度分级：1级，无重叠；2级，重叠小于阴影的一半；3级，重叠超过一半。然后，我们进行了一项回顾性队列研究，纳入了329例行脊柱手术患者的329个肩部。在站立位侧位X线平片上测量脊柱排列参数（SPAPs），包括颈椎前凸（CL）、胸椎后凸（TK）、腰椎前凸（LL）、骨盆入射角、骨盆倾斜度、骶骨斜率和矢状垂直轴。在正位X线片和三维计算机断层扫描上计算关节盂前倾角（GAT）和关节盂前翻角（GAVA）。研究SPAPs与每个角度之间的相关性，并在多变量分析中寻找独立影响因素。比较各分级之间的个体因素、GAT、GAVA和SPAPs。
与GAT相关的SPAPs为矢状垂直轴（R = 0.14，P = 0.011）、TK（R = 0.12，P = 0.026）和LL（R = -0.11，P = 0.046）。多变量分析确定TK和LL为独立影响因素（TK，P = 0.001；LL，P = 0.008）。与GAVA相关的SPAPs为CL（R = 0.17，P = 0.002）、TK（R = 0.29，P < 0.001）和LL（R = 0.25，P < 0.001）。多变量分析确定CL、TK和LL为独立影响因素（CL，P = 0.01；TK，P = 0.03；LL，P = 0.03）。分别有183、127和19例被分类为1级、2级和3级。GAT（1级，24.0±7.8；2级，32.4±7.0；3级，41.0±7.8）、GAVA（1级，29.3±7.6；2级，33.7±9.5；3级，31.5±8.3）和TK（1级，30.6±13.6；2级，35.1±14.2；3级，43.1±20.4）根据分级有显著差异。
我们确定了影响肩胛位置的因素，并证明可以通过使用X线平片的分级系统来估计肩胛位置。
