Franceschetti Edoardo, Perricone Giovanni, De Rosa Antonino, Tanzilli Andrea, Gregori Pietro, Giurazza Giancarlo, Zampogna Biagio, Shanmugasundaram Saseendar, Papalia Rocco
Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
J Clin Orthop Trauma. 2024 Sep 3;56:102527. doi: 10.1016/j.jcot.2024.102527. eCollection 2024 Sep.
Increasing the impingement-free Range Of Movement (ROM) is crucial for improving patient's functional outcome and reducing the rate of scapular notching. The purpose of this study was to compare, in a virtual model of Reverse Shoulder Arthroplasty with glenoid lateralization (L-RSA): 1) the impingement-free range of movement (ROM) between 155° Grammont-style inlay stem and 135° flushlay stem; 2) the effect of glenosphere size and type (centered vs eccentric) on impingement-free range of movement (ROM) using a 135° Neck Shaft Angle (NSA) flushlay stem.
200 CT-scans of patients undergoing shoulder replacement for Cuff tear Arthropathy were analyzed in the present study. Virtual implantation of L-RSA was performed using the same glenoid implant and two stems, 155° inlay Grammont-style stem and 135° flushlay stem. For 135° stem, three different glenoid size (36 mm, 39 mm and 42 mm) were tried, as well as two glenoid type (centered and eccentric glenoid), while for 155° stem were tried two different glenoid size (36 mm and 42 mm), as well as two glenoid type (centered and eccentric glenoid). For both stems, two different baseplates (25 mm e 29 mm) were used. Finally, impingement-free ROM for each configuration and each stem was then calculated by the software and collected.
Increasing the glenosphere size demonstrated an increase in impingement-free ROM in both 25 mm and 29 mm baseplate groups (p < 0.01). Similarly, using eccentric glenoid type improved impingement-free ROM in the two subgroups (p < 0.01). When comparing inlay and flushlay designs, flushlay shows better total impingement-free ROM as well as better impingement-free ROM in all movements apart from abduction (p < 0.01).
This study demonstrated a correlation between glenoid size and glenoid type and impingement-free ROM using 135° flushlay stems. In particular, using a greater glenoid size and eccentric glenoid type allows for more mobility. When comparing 135° flushlay stem with 155° inlay stem, 135° stem allows greater mobility in all movements except for abduction.
增加无撞击活动范围（ROM）对于改善患者功能结局和降低肩胛切迹发生率至关重要。本研究的目的是在一个采用关节盂侧方移位的反肩关节置换术（L-RSA）虚拟模型中比较：1）155°Grammont式镶嵌柄与135°平齐柄之间的无撞击活动范围（ROM）；2）使用135°颈干角（NSA）平齐柄时，关节盂球窝大小和类型（中心型与偏心型）对无撞击活动范围（ROM）的影响。
本研究分析了200例因肩袖撕裂性关节病接受肩关节置换患者的CT扫描图像。使用相同的关节盂植入物和两种柄进行L-RSA的虚拟植入，即155°Grammont式镶嵌柄和135°平齐柄。对于135°柄，尝试了三种不同的关节盂尺寸（36mm、39mm和42mm）以及两种关节盂类型（中心型和偏心型），而对于155°柄，尝试了两种不同的关节盂尺寸（36mm和42mm）以及两种关节盂类型（中心型和偏心型）。对于两种柄，均使用了两种不同的基板（25mm和29mm）。最后，通过软件计算并收集每种配置和每种柄的无撞击ROM。
在25mm和29mm基板组中，增加关节盂球窝尺寸均显示无撞击ROM增加（p<0.01）。同样，使用偏心型关节盂类型在两个亚组中均改善了无撞击ROM（p<0.01）。比较镶嵌式和平齐式设计时，平齐式在除外展外的所有运动中均显示出更好的总无撞击ROM以及更好的无撞击ROM（p<0.01）。
本研究证明了使用135°平齐柄时关节盂大小、关节盂类型与无撞击ROM之间的相关性。特别是，使用更大的关节盂尺寸和偏心型关节盂类型可实现更大的活动度。将135°平齐柄与155°镶嵌柄进行比较时，135°柄在除外展外的所有运动中均具有更大的活动度。
