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有限元分析（共两部分，第二部分）：对于解剖型和反向无柄肩关节植入物，盂肱关节骨应力分布取决于植入物构型。

Finite element analysis part 2 of 2: Glenohumeral bone stress distribution depends on implant configuration for anatomic and reverse stemless shoulder implants.

作者信息

Housset Victor, Srikumaran Umasuthan, Daudet Jean-Marie, Fradet Léo, Bianco Rohan-Jean, Nourissat Geoffroy

机构信息

Hôpital Henri-Mondor, Université Paris-Est Créteil Créteil France.

Groupe Maussins, Clinique Maussins Nollete-Ramsay Santé Paris France.

出版信息

J Exp Orthop. 2024 Sep 19;11(3):e70001. doi: 10.1002/jeo2.70001. eCollection 2024 Jul.

DOI:10.1002/jeo2.70001
PMID:39301206
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11411269/
Abstract

PURPOSE

Our purpose was to quantify stresses in the bone surrounding stemless implants in various configurations.

METHODS

A detailed finite element model of the glenohumeral joint was used to simulate abduction kinematics before and after arthroplasty and to measure bone stresses around the implants. Two digital patients were simulated: one healthy and one with supraspinatus muscle impairment (deficiency). Two anatomic total shoulder arthroplasty (TSA) configurations were placed in a 135° cutting plane. Two reverse shoulder arthroplasty (RSA) configurations with cutting angles of 135° and 145° were simulated with asymmetrical and symmetrical polyethylene cups, respectively, to obtain humeral neck-shaft angles of 145°.

RESULTS

Compared with preoperative models, TSA preserved and RSA restored abduction kinematics. The bone mechanical stresses were located mainly around the central stud of the TSA and were more peripheral to the RSA humeral components. The RSA configuration with the 145° cutting angle and symmetrical cup generated the lowest maximal bone stress and bone volume involvement. Stresses in the scapular cortical bone were highest in the supraspinatus fossa for TSA and the crest of the acromion for RSA.

CONCLUSION

Early stability and glenohumeral bone stress change with implant configuration and should not be extrapolated from anatomic clinical data to reverse configurations.

LEVEL OF EVIDENCE

Diagnostic tests or criteria; Level IV.

摘要

目的

我们的目的是量化各种构型的无柄植入物周围骨骼中的应力。

方法

使用一个详细的盂肱关节有限元模型来模拟关节置换术前和术后的外展运动学，并测量植入物周围的骨应力。模拟了两名数字患者：一名健康患者和一名患有冈上肌损伤（缺损）的患者。将两种解剖型全肩关节置换术（TSA）构型置于135°的截骨平面。分别用不对称和对称聚乙烯杯模拟两种截骨角度为135°和145°的反向肩关节置换术（RSA）构型，以获得145°的肱骨干颈角。

结果

与术前模型相比，TSA保留了外展运动学，RSA恢复了外展运动学。骨机械应力主要位于TSA的中心柱周围，而在RSA肱骨头组件周围更靠外周。截骨角度为145°且使用对称杯的RSA构型产生的最大骨应力和骨体积累及最小。肩胛皮质骨中的应力在TSA中冈上肌窝最高，在RSA中肩峰嵴最高。

结论

早期稳定性和盂肱骨应力随植入物构型而变化，不应从解剖学临床数据外推至反向构型。

证据水平

诊断试验或标准；IV级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/c2e7a1fc2d33/JEO2-11-e70001-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/9c1f9150a532/JEO2-11-e70001-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/f459a68de6c9/JEO2-11-e70001-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/b626803b84ea/JEO2-11-e70001-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/d1c3b9540930/JEO2-11-e70001-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/c2e7a1fc2d33/JEO2-11-e70001-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/9c1f9150a532/JEO2-11-e70001-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/f459a68de6c9/JEO2-11-e70001-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/b626803b84ea/JEO2-11-e70001-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/d1c3b9540930/JEO2-11-e70001-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9607/11411269/c2e7a1fc2d33/JEO2-11-e70001-g002.jpg

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Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study.
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