Pearl M L, Volk A G
Arthritis Service, Rancho Los Amigos Medical Center, Downey, CA, USA.
J Shoulder Elbow Surg. 1995 Jul-Aug;4(4):286-9. doi: 10.1016/s1058-2746(05)80022-9.
Arthroplasty of the proximal humerus positions a prosthetic articular surface in relation to the humeral canal. Most descriptions of surgical technique recommend positioning the humeral component in 30 degrees to 45 degrees of retroversion. This study measured retroversion in relationship to the surgically reamed canal and introduced a method of measurement pertinent to prosthetic reconstruction. The canals of 21 cadaveric humeri were surgically reamed, the articular margins of the humeral heads were outlined with steel wire, and the trochlear axes were transfixed with Steinman pins. Under fluoroscopy the humeri were rotated on a jig that allowed rotation around the reamer and measurement of retroversion relative to the plane of the articular surface. Retroversion of the proximal humerus is highly variable, ranging in this study from 10 degrees to 55 degrees (mean 29.8 degrees). Anatomic reconstruction of the retroversion angle must be individualized. Palpation of the rotator cuff insertion is recommended prior to humeral head resection to avoid inadvertant cuff injury.
肱骨近端关节成形术是将人工关节面相对于肱骨髓腔进行定位。大多数手术技术描述建议将肱骨组件置于30度至45度的后倾位。本研究测量了相对于手术扩髓后的髓腔的后倾角度，并引入了一种与假体重建相关的测量方法。对21具尸体肱骨的髓腔进行手术扩髓，用钢丝勾勒出肱骨头的关节边缘，并用斯氏针固定滑车轴线。在荧光透视下，将肱骨在一个夹具上旋转，该夹具允许围绕扩髓器旋转并测量相对于关节面平面的后倾角度。肱骨近端的后倾角度变化很大，在本研究中范围为10度至55度（平均29.8度）。后倾角度的解剖重建必须个体化。建议在切除肱骨头之前触诊肩袖止点，以避免意外损伤肩袖。
