Akgün Doruk, Paksoy Alp, Siegert Paul, Weiß Isabella, Moroder Philipp
Center for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany.
The Orthopaedic Hospital Vienna-Speising, Vienna, Austria.
JSES Int. 2025 May 6;9(4):1319-1326. doi: 10.1016/j.jseint.2025.03.021. eCollection 2025 Jul.
There is currently no in depth description of glenoid vault morphology, the rotator cuff action lines, and scapulothoracic orientation in patients with shoulder osteoarthritis (OA). Therefore, the goal of this study was to provide a quantitative analysis of these parameters in Walch types A, B, and C, along with rotator cuff action lines, scapulothoracic orientation, and humeral head centering compared to healthy controls.
Patients who were treated for primary shoulder OA in our hospital between 2010 and 2018 were included in this retrospective case-control study. The cases were categorized into type A, B, and C according to their glenoid morphology on computed tomography using the modified Walch classification and compared with a healthy control group in a matched-pair analysis (matching by age, gender, and affected side). The glenoid version, glenoid inclination, glenohumeral and scapulohumeral head centering, neck angle, glenoid and humeral offset, subscapularis (SSC) and infraspinatus (ISP) tendon traction vectors, and an overall rotator cuff (RC) vector were measured in a standardized axial plane. The protraction, internal rotation, upward rotation, translation, and tilt of the scapula were also measured in three-dimensional reconstructions.
A total of 59 shoulders in 47 patients were identified with the following distribution of Walch glenoid types: 24 type A, 30 type B, and 5 type C glenoids. Type A glenoids showed no differences compared to their control group except significantly higher SSC angle, higher resultant RC vector, and lower scapular tilt. Type B glenoids had higher glenoid version, lower glenoid inclination, higher SSC angle, lower ISP angle, higher resultant RC vector, and more posterior humeral offset in comparison with their control group. Scapulothoracic orientation measurements for type B glenoids indicated significantly reduced scapular internal and upward rotation, and lower scapular tilt compared to controls. Type C glenoids showed significantly higher glenoid version, lower glenoid inclination, higher posterior humeral offset, and lower ISP angle with no significant change in the resultant RC vector in comparison with their control group.
Patients with primary OA and glenoid type A barely show differences in scapular morphology and scapulathoracic orientation compared to a healthy control group. In contrast, patients with glenoid type B or C showed significant differences of scapulohumeral centering in glenoid version, humeral offset, and glenoid inclination compared to controls. Furthermore, despite the changes of SSP and ISP angles in type B glenoids, the humeral head stayed centered to the glenoid fossa.
目前尚无对肩骨关节炎（OA）患者的肩胛盂穹窿形态、肩袖作用线和肩胛胸壁方向进行深入描述。因此，本研究的目的是对Walch A、B和C型患者的这些参数进行定量分析，并与健康对照组比较肩袖作用线、肩胛胸壁方向和肱骨头中心位置。
本回顾性病例对照研究纳入了2010年至2018年在我院接受原发性肩OA治疗的患者。根据计算机断层扫描上的肩胛盂形态，使用改良的Walch分类法将病例分为A、B和C型，并在配对分析中与健康对照组进行比较（按年龄、性别和患侧配对）。在标准化轴平面上测量肩胛盂版本、肩胛盂倾斜度、盂肱和肩胛肱骨头中心位置、颈角、肩胛盂和肱骨偏移、肩胛下肌（SSC）和冈下肌（ISP）肌腱牵引向量以及整体肩袖（RC）向量。还在三维重建中测量肩胛骨的前伸、内旋、上旋、平移和倾斜。
共确定了47例患者的59个肩部，Walch肩胛盂类型分布如下：24个A型、30个B型和5个C型肩胛盂。A型肩胛盂与对照组相比无差异，只是SSC角显著更高、合成RC向量更高以及肩胛骨倾斜度更低。与对照组相比，B型肩胛盂的肩胛盂版本更高、肩胛盂倾斜度更低、SSC角更高、ISP角更低、合成RC向量更高以及肱骨后偏移更多。B型肩胛盂的肩胛胸壁方向测量结果表明，与对照组相比，肩胛骨的内旋和上旋显著减少，肩胛骨倾斜度更低。与对照组相比，C型肩胛盂的肩胛盂版本显著更高、肩胛盂倾斜度更低、肱骨后偏移更高以及ISP角更低，合成RC向量无显著变化。
与健康对照组相比，原发性OA和A型肩胛盂患者在肩胛骨形态和肩胛胸壁方向上几乎没有差异。相比之下，B型或C型肩胛盂患者在肩胛盂版本、肱骨偏移和肩胛盂倾斜度方面的肩胛肱中心位置与对照组有显著差异。此外，尽管B型肩胛盂的SSP和ISP角发生了变化，但肱骨头仍位于肩胛盂窝中心。
