Thiel Grace E, Nguyen Brandon T, Dennis Jennifer F
College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA.
Kansas City University Graduate Medical Education Consortium (KCU-GME Consortium)/HCA Healthcare Kansas City Program, Kansas City, MO, USA.
J Orthop. 2024 Nov 12;64:13-17. doi: 10.1016/j.jor.2024.10.049. eCollection 2025 Jun.
In reverse total shoulder arthroplasty, a humeral osteotomy is typically performed at the anatomic neck. The quality and quantity of cancellous and cortical bone impacts sizing of implants. Little-to-no information exists characterizing the transition of this bone quality at this location. This cadaveric study focused on measuring and analyzing the transition zone of the proximal humerus bone quality to better understand the implications of utilizing different implant sizes during reverse total shoulder arthroplasty. This assessment was conducted through the usage of a newly designed indentation depth probe.
An Exactech, Inc. designed indentation depth probe was used to assess the transition from cancellous to cortical bone in 45 cadavers after a humeral osteotomy was performed. The thickness of the cortical rim was measured in regard to superior, inferior, anterior, and posterior quadrants. Linear regressions were utilized to evaluate the relationship between anatomic location in regard to cortical bone thickness. Independent sample two-tailed t-tests were also conducted to examine the relationship between spring force and bone thickness. Finally, independent sample two-tailed t-tests or Mann-Whitney U tests were utilized to examine the relationship between cortical thickness and variables including sex, age, osteoporosis, and a diagnosis of cancer.
All linear regressions were found to be insignificant excluding the relationships between inferior to anterior (p = 0.003) and inferior to posterior (p = 0.001). All t-tests and Mann-Whitney U tests were found to be insignificant, except for the relationship between age and the posterior aspect (p = 0.04).
In our cohort, cortical bone thickness was not impacted by sex, diagnosis of osteoporosis, or diagnosis of cancer. Interestingly, age was found to only have an impact on the posterior aspect of the cortical bone rim. Differences in cortical bone thickness were also found in regard to both the inferior to anterior and inferior to posterior comparisons.
This suggests that differences in cortical bone thickness can occur, and that one point of assessment might not be sufficient.
在反式全肩关节置换术中，肱骨截骨术通常在解剖颈处进行。松质骨和皮质骨的质量和数量会影响植入物的尺寸选择。关于该部位骨质量转变的特征，几乎没有相关信息。这项尸体研究聚焦于测量和分析肱骨近端骨质量的过渡区，以更好地理解在反式全肩关节置换术中使用不同尺寸植入物的影响。该评估通过使用一种新设计的压痕深度探针进行。
在45具尸体上进行肱骨截骨术后，使用Exactech公司设计的压痕深度探针评估从松质骨到皮质骨的转变。测量皮质边缘在上方、下方、前方和后方象限的厚度。利用线性回归评估解剖位置与皮质骨厚度之间的关系。还进行了独立样本双尾t检验，以检查弹簧力与骨厚度之间的关系。最后，利用独立样本双尾t检验或曼-惠特尼U检验来检查皮质厚度与包括性别、年龄、骨质疏松症和癌症诊断在内的变量之间的关系。
除下方与前方（p = 0.003）和下方与后方（p = 0.001）的关系外，所有线性回归均无显著意义。所有t检验和曼-惠特尼U检验均无显著意义，除了年龄与后方区域的关系（p = 0.04）。
在我们的研究队列中，皮质骨厚度不受性别、骨质疏松症诊断或癌症诊断的影响。有趣的是，发现年龄仅对皮质骨边缘的后方区域有影响。在下方与前方以及下方与后方的比较中，皮质骨厚度也存在差异。
这表明皮质骨厚度可能存在差异，单点评估可能并不充分。
