Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan.
Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi-Ku, Fukuoka City, Fukuoka, 813-8503, Japan.
J Orthop Surg Res. 2024 Nov 27;19(1):801. doi: 10.1186/s13018-024-05292-9.
Few studies have investigated the correlation between shoulder kinematics and clinical outcomes in patients undergoing rotator cuff repair using dynamic analysis. This study assessed shoulder kinematics before and after surgical repair in patients with rotator cuff tears (RCTs) and determined the relationship among shoulder kinematics and between shoulder kinematics and clinical outcomes.
Ten patients with large-to-massive RCTs and 10 control participants were included. In vivo shoulder kinematics during scapular plane abduction were measured preoperatively and 1 year postoperatively using validated image-registration techniques and compared among the control, preoperative, and postoperative groups. Mixed models were used to compare the effects of the groups on shoulder kinematics, followed by Tukey's honest significant difference test. Pearson's correlation coefficient was used to identify the correlations among shoulder kinematics and between each kinematic and clinical outcome.
The scapula, tilted more anteriorly preoperatively, was not different from the control group postoperatively. Additionally, the change in scapular posterior tilt (PT) throughout dynamic abduction was 18.17° ± 3.59° in the postoperative group, greater than that in the control group (11.54° ± 2.29°; p = 0.0037). The postoperative change in PT significantly correlated with acromiohumeral distance (AHD) and rotator cuff integrity (Sugaya classification) (AHD: r = 0.71, p = 0.023; Sugaya classification: r = - 0.75, p = 0.013), but not preoperative change in PT. Functional score improved from preoperative to postoperative (p < 0.0001). Abduction angle and functional score significantly correlated with Sugaya classification (abduction angle: r = - 0.67, p = 0.034; functional score: r = - 0.70, p = 0.025) but not with shoulder kinematics. Mean superior translation of the humeral head and AHD throughout abduction changed from 1.77 ± 1.34 to 0.61 ± 1.37 and 1.44 ± 1.59 to 2.71 ± 2.27 mm, respectively, from preoperative to postoperative (both p < 0.0001).
After the surgical repair of large-to-massive RCTs, glenohumeral stability normalized, and the more anteriorly tilted orientation of the scapula improved. Additionally, the preoperative increased scapular motion throughout dynamic abduction was further enhanced postoperatively. Interestingly, in postoperative patients, scapular motion toward PT during dynamic abduction correlated with minimum AHD and cuff healing.
很少有研究通过动态分析来研究肩运动学与肩袖修复术后患者临床结果之间的相关性。本研究评估了肩袖撕裂（RCT）患者手术修复前后的肩运动学，并确定了肩运动学之间以及肩运动学与临床结果之间的关系。
纳入 10 例大到巨大 RCT 患者和 10 例对照参与者。使用验证后的图像配准技术，在术前和术后 1 年测量肩胛平面外展过程中的肩运动学，并在对照组、术前组和术后组之间进行比较。采用混合模型比较各组对肩运动学的影响，然后采用 Tukey 氏显着性差异检验。采用 Pearson 相关系数确定肩运动学之间以及每个运动学与临床结果之间的相关性。
术前肩胛骨前倾程度更大，术后与对照组无差异。此外，术后动态外展过程中肩胛骨后倾（PT）的变化为 18.17°±3.59°，大于对照组的 11.54°±2.29°（p=0.0037）。PT 的术后变化与肩峰肱骨头距离（AHD）和肩袖完整性（Sugaya 分类）显著相关（AHD：r=0.71，p=0.023；Sugaya 分类：r=-0.75，p=0.013），但与术前 PT 变化无关。术后功能评分较术前改善（p<0.0001）。外展角度和功能评分与 Sugaya 分类显著相关（外展角度：r=-0.67，p=0.034；功能评分：r=-0.70，p=0.025），但与肩运动学无关。肩峰肱骨头的平均上移和 AHD 在整个外展过程中从术前的 1.77±1.34mm 变为 0.61±1.37mm 和 1.44±1.59mm 变为 2.71±2.27mm，差异均有统计学意义（均 p<0.0001）。
在大到巨大 RCT 的手术修复后，盂肱关节稳定性正常化，肩胛骨前倾程度得到改善。此外，术后动态外展过程中肩胛骨运动幅度进一步增加。有趣的是，在术后患者中，动态外展过程中肩胛骨向 PT 的运动与最小 AHD 和肩袖愈合相关。
