Nagawa Keita, Hara Yuki, Kakemoto Shinji, Shiratori Taira, Kaizu Akane, Koyama Masahiro, Inoue Kaiji, Sakaguchi Katsunobu, Kozawa Eito
Radiology, Saitama Medical University, Saitama, JPN.
Orthopedics, Saitama Medical University, Saitama, JPN.
Cureus. 2024 Dec 2;16(12):e74963. doi: 10.7759/cureus.74963. eCollection 2024 Dec.
In this study, we evaluated serial changes in shoulder muscle volume and computed tomography (CT) density of the transverse force couple (i.e., subscapularis (Ssc) vs. infraspinatus and teres minor (Isp+TM) muscles) after Bankart repair surgery in patients with anterior shoulder instability (ASI).
Four consecutive CT scans (obtained preoperatively and postoperatively at 1 month, 6 months, and 12 months) of 24 shoulders from 24 patients who underwent arthroscopic rotator cuff repair were examined. To generate muscle models, the Ssc and Isp+TM muscles were segmented. The reconstructed models were separated by the Y-view plane, and the planes were situated 2.5 cm and 5 cm medial to the Y-view plane. Balance was evaluated using volume ratio (VR) and computed tomography-density ratio (CT-DR) in each section of both groups, employing a three-dimensional sectional approach. Changes in these values were correlated with the preoperative background factors.
Shoulder muscle volume and CT density were decreased in the early postoperative period compared with the preoperative period but recovered through the late postoperative period. The mean VR decreased in all sections in the early postoperative period but increased thereafter, whereas the mean CT-DR in all sections remained mostly unchanged throughout the perioperative period. Furthermore, the perioperative differences in muscle volume were correlated with sex, work and sports activity level, Hill-Sachs lesion, and range of motion. Perioperative differences in CT density were not correlated with most items, except for sulcus signs.
Serial changes in the VR group were significantly different and had clinical implications, whereas changes in the CT-DR group were not significantly different. This method may provide a potential indicator for evaluating muscle balance and recovery after Bankart repair surgery for ASI.
在本研究中，我们评估了前肩不稳（ASI）患者在Bankart修复手术后，肩部肌肉体积以及横向力偶（即肩胛下肌（Ssc）与冈下肌和小圆肌（Isp+TM））的计算机断层扫描（CT）密度的系列变化。
对24例接受关节镜下肩袖修复手术患者的24个肩部进行连续4次CT扫描（术前、术后1个月、6个月和12个月）。为生成肌肉模型，对Ssc和Isp+TM肌肉进行分割。重建模型通过Y视图平面分开，这些平面位于Y视图平面内侧2.5 cm和5 cm处。采用三维截面方法，使用体积比（VR）和计算机断层扫描密度比（CT-DR）评估两组各截面的平衡情况。这些值的变化与术前背景因素相关。
与术前相比，术后早期肩部肌肉体积和CT密度降低，但在术后晚期恢复。术后早期所有截面的平均VR均降低，但此后升高，而所有截面的平均CT-DR在围手术期大多保持不变。此外，肌肉体积的围手术期差异与性别、工作和运动活动水平、Hill-Sachs损伤以及活动范围相关。CT密度的围手术期差异除了与沟征外，与大多数项目均无相关性。
VR组的系列变化有显著差异且具有临床意义，而CT-DR组的变化无显著差异。该方法可能为评估ASI患者Bankart修复手术后的肌肉平衡和恢复提供一个潜在指标。
