Harryman D T, Sidles J A, Harris S L, Lippitt S B, Matsen F A
Department of Orthopaedics, School of Medicine, University of Washington, Seattle 98195, USA.
J Bone Joint Surg Am. 1995 Apr;77(4):555-63. doi: 10.2106/00004623-199504000-00008.
We used a cadaveric model to examine the mechanical effects of changes in the conformity of the articular surfaces and the size of the humeral head component in glenohumeral arthroplasty. The experimental system permitted a manual clinical examination of the glenohumeral joint while sensors monitored the humeroscapular position and orientation as well as the forces and torques applied by the examiner. Four preparations were compared: an anatomical humeroscapular preparation and three glenohumeral arthroplasty preparations (one with anatomically sized components and a radius of curvature of the glenoid that was four millimeters larger than that of the humeral head, one with anatomically sized components and a radius of curvature of the glenoid that was equal to that of the humeral head, and one with a non-anatomical, large humeral head component and a radius of curvature of the glenoid that was equal to that of the humeral head). All motions, including flexion, external and internal rotation, and maximum elevation, were diminished with use of the non-anatomical, large humeral head component. Laxity of the joint on drawer and sulcus tests was not affected by the conformity of the articular surfaces but was decreased significantly by implantation of the large humeral head component. The kinematics of the glenohumeral joint were not markedly altered by reduction of the uniformity between the articular surfaces of the prosthetic components. In all preparations, obligate displacement of the humeral head associated with a passive range of motion occurred at smaller angles with the large humeral head component.
我们使用尸体模型来研究关节盂肱关节置换术中关节面贴合度变化及肱骨头假体大小对力学的影响。该实验系统允许对关节盂肱关节进行手动临床检查，同时传感器监测肩胛肱骨的位置和方向以及检查者施加的力和扭矩。比较了四种标本：一个解剖学上的肩胛肱骨标本和三种关节盂肱关节置换标本（一种使用解剖学尺寸的假体组件，关节盂的曲率半径比肱骨头大4毫米；一种使用解剖学尺寸的假体组件，关节盂的曲率半径与肱骨头相等；一种使用非解剖学的大尺寸肱骨头假体组件，关节盂的曲率半径与肱骨头相等）。使用非解剖学的大尺寸肱骨头假体组件时，所有运动，包括屈曲、外旋和内旋以及最大抬高，均减弱。抽屉试验和沟试验中关节的松弛度不受关节面贴合度的影响，但大尺寸肱骨头假体组件的植入使其显著降低。假体组件关节面之间一致性的降低并未明显改变关节盂肱关节的运动学。在所有标本中，与被动活动范围相关的肱骨头强制性移位在使用大尺寸肱骨头假体组件时发生的角度更小。
