Jeon Young Dae, Heo Kang, Tran Luan Khoi, Yoon Ji Young, Jeong Hyeon Jang, Oh Joo Han
Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Orthopaedic Surgery, Uijeonbu SeoulChuk Hospital, Uijeonbu, Republic of Korea.
J Shoulder Elbow Surg. 2025 Apr;34(4):e187-e195. doi: 10.1016/j.jse.2024.07.009. Epub 2024 Aug 19.
Humeral component retroversion (HcRV) can be customized to match native humeral retroversion (RV) during reverse total shoulder arthroplasty. However, assessing postoperative individualized HcRV using computed tomography (CT) scans without an elbow can be challenging. Therefore, we developed a new method to obtain the HcRV and evaluated its reliability.
A total of 106 patients underwent reverse total shoulder arthroplasty using a single implant, in which the humeral component was implanted based on the preoperative humeral RV (Pre_HRV) using a bilateral CT scan of the elbow. Intraoperatively, a RV guide with version hole at 10° intervals was used; Pre_HRV was converted to 5° increments and applied for humeral component implantation. The axis of intertubercular sulcus (ITS) was defined as the line perpendicular to the intertubercular line, and the angle between the axis of ITS and the transepicondylar axis was defined as the bicipital groove rotation (BGR). ITS orientation was defined as the angle between the axis of ITS and the central axis of the humeral head. Since the BGR does not change, the postoperatively implanted HcRV (Post_HcRV)f is calculated as the BGR minus the value of the postoperative ITS orientation. An agreement analysis was performed between Post_HcRV and both the intraoperatively applied humeral RV and Pre_HRV, as well as between the preoperative and postoperative ITS orientations. The humeral component's insertional errors were also evaluated.
All radiologic measurements exhibited excellent interobserver and intraobserver reliabilities. The reliabilities between Post_HcRV and both intraoperatively applied humeral RV and Pre_HRV, as well as between preoperative and postoperative ITS orientations, showed excellent agreement (intraclass correlation coefficients: 0.953, 0.952, and 0.873, respectively). The humeral component was inserted within 5° in 86.8% of the planned humeral RV cases.
The HcRV measured using the BGR and ITS orientations achieved good accuracy for restoring the planned humeral RV using a RV guide with the forearm axis. Therefore, this new radiological measurement method can aid orthopedic surgeons in confirming Post_HcRV on CT scans without an elbow.
在反式全肩关节置换术中，肱骨假体后倾（HcRV）可进行定制以匹配天然肱骨后倾（RV）。然而，在不包括肘部的情况下使用计算机断层扫描（CT）评估术后个体化HcRV可能具有挑战性。因此，我们开发了一种获取HcRV的新方法并评估了其可靠性。
共有106例患者接受了使用单一植入物的反式全肩关节置换术，其中肱骨假体根据术前肱骨RV（Pre_HRV）通过肘部的双侧CT扫描进行植入。术中，使用了每隔10°有角度孔的后倾导向器；Pre_HRV转换为5°增量并应用于肱骨假体植入。结节间沟（ITS）的轴线定义为垂直于结节间线的线，ITS轴线与经髁轴线之间的角度定义为二头肌沟旋转（BGR）。ITS方向定义为ITS轴线与肱骨头中心轴线之间的角度。由于BGR不变，术后植入的HcRV（Post_HcRV）通过BGR减去术后ITS方向的值来计算。对Post_HcRV与术中应用的肱骨RV和Pre_HRV之间，以及术前和术后ITS方向之间进行一致性分析。还评估了肱骨假体的插入误差。
所有影像学测量均表现出极好的观察者间和观察者内可靠性。Post_HcRV与术中应用的肱骨RV和Pre_HRV之间，以及术前和术后ITS方向之间的可靠性显示出极好的一致性（组内相关系数分别为：0.953、0.952和0.873）。在86.8%的计划肱骨RV病例中，肱骨假体插入角度在5°以内。
使用BGR和ITS方向测量的HcRV在使用带有前臂轴线的后倾导向器恢复计划的肱骨RV方面具有良好的准确性。因此，这种新的影像学测量方法可帮助骨科医生在不包括肘部的CT扫描上确认Post_HcRV。
