Payne L Z, Deng X H, Craig E V, Torzilli P A, Warren R F
Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 1997 Nov-Dec;25(6):801-8. doi: 10.1177/036354659702500612.
Ten human cadaveric shoulders were tested with a dynamic shoulder model simulating physiologic rotator cuff, deltoid, and biceps muscle forces. The combined effect of the muscle forces and acromial structure on subacromial impingement was measured with minimally invasive, miniature pressure transducers. Shoulders with large acromial spurs had significantly greater impingement pressures at the anterolateral acromion in neutral, internal, and external rotation compared with those with flatter acromia. Application of a biceps muscle force reduced anterolateral acromial pressures by 10%. Failure to simulate a supraspinatus force decreased acromial pressure 52% in shoulders with type III acromia in neutral rotation. Without rotator cuff forces applied, the maximum deltoid muscle force required to elevate the arm increased by 17%. Acromial pressures were increased when no rotator cuff forces were applied, but the increases were not significant. After an anterior acromioplasty, pressures decreased by 99% anteriorly. However, failure to achieve a flat surface posteriorly increased pressures in this location, especially with the shoulder in external rotation. Modeling the rotator cuff and deltoid muscle forces demonstrated the importance of the muscular force couple to center the humeral head during elevation of the arm. The inferior forces of the infraspinatus, teres minor, and subscapularis muscles were necessary to neutralize the superior shear force produced by the deltoid and supraspinatus muscles.
使用动态肩部模型对十具人类尸体肩部进行测试，该模型模拟了生理状态下的肩袖、三角肌和肱二头肌的力量。采用微创微型压力传感器测量肌肉力量和肩峰结构对肩峰下撞击的综合影响。与肩峰较平的肩部相比，有大肩峰骨刺的肩部在中立位、内旋和外旋时，肩峰前外侧的撞击压力明显更大。施加肱二头肌力量可使肩峰前外侧压力降低10%。在中立位旋转时，对于III型肩峰的肩部，不模拟冈上肌力量会使肩峰压力降低52%。在不施加肩袖力量的情况下，抬高手臂所需的最大三角肌力量增加了17%。不施加肩袖力量时，肩峰压力会升高，但升高并不显著。在进行前肩峰成形术后，前方压力降低了99%。然而，未能使后方表面变平会增加该部位的压力，尤其是在肩部外旋时。模拟肩袖和三角肌力量表明，在手臂抬高过程中，肌肉力偶对于使肱骨头居中非常重要。冈下肌、小圆肌和肩胛下肌的向下力量对于抵消三角肌和冈上肌产生的向上剪切力是必要的。
