Paletta G A, Warner J J, Warren R F, Deutsch A, Altchek D W
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, USA.
J Shoulder Elbow Surg. 1997 Nov-Dec;6(6):516-27. doi: 10.1016/s1058-2746(97)90084-7.
The goals of this study were to define biplanar glenohumeral kinematics and glenohumeral-scapulothoracic motion relationships in normal patients with a two-plane radiograph series and then in patients with anterior shoulder instability or rotator cuff tear both before surgery and after surgical repair and postoperative rehabilitation. A two-plane radiographic series of x-ray films in the scapular and horizontal (axillary) planes was performed. With these films, measurements of the relationship between the centers of the humeral head and glenoid and measurements of the component contributions of glenohumeral and scapulothoracic motion to total arm abduction were made. Six normal adults underwent x-ray evaluation to establish normal control values. Kappa analysis was used to determine reliability of technique. Eighteen patients with confirmed anterior shoulder instability (group A) and 15 with confirmed rotator cuff tears (group B) were studied before surgery. Seven (39%) of 18 of the patients in group A and all 15 (100%) of the patients in group B demonstrated superior translation of the humeral head during scapular plane abduction. In the horizontal plane 14 (78%) of 18 patients in group A (instability) and none in group B (rotator cuff tear) demonstrated abnormal anterior translation of the humeral head on the glenoid. Both groups demonstrated altered glenohumeral-scapulothoracic motion relationships compared with the normal control group. Two years after surgery 12 patients from group A and 14 patients from group B were restudied. All of these patients had demonstrated abnormalities of humeral head translation before surgery. For group A 12 (100%) of 12 patients demonstrated normal glenohumeral kinematics in both planes after open anterior stabilization. For group B 12 (86%) of 14 patients demonstrated normal glenohumeral kinematics in both planes after open rotator cuff repair. In group A the altered glenohumeral-scapulothoracic motion relationships persisted, whereas in group B these relationships became normal.
本研究的目的是通过双平面X线片系列确定正常患者的双平面盂肱关节运动学以及盂肱关节与肩胛胸壁运动的关系，然后在肩前方不稳定或肩袖撕裂患者术前、手术修复及术后康复后进行同样的研究。进行了肩胛骨平面和水平（腋窝）平面的双平面X线片系列检查。利用这些片子，测量了肱骨头中心与关节盂之间的关系，以及盂肱关节和肩胛胸壁运动对全臂外展的组成贡献。6名正常成年人接受了X线评估以建立正常对照值。采用Kappa分析确定技术的可靠性。18例确诊为肩前方不稳定的患者（A组）和15例确诊为肩袖撕裂的患者（B组）在术前进行了研究。A组18例患者中有7例（39%）、B组所有15例患者（100%）在肩胛骨平面外展时表现出肱骨头向上移位。在水平面上，A组（不稳定）18例患者中有14例（78%）、B组（肩袖撕裂）无患者表现出肱骨头在关节盂上的异常向前移位。与正常对照组相比，两组均表现出盂肱关节与肩胛胸壁运动关系的改变。术后两年，对A组12例患者和B组14例患者进行了再次研究。所有这些患者术前均表现出肱骨头移位异常。对于A组，12例患者中有12例（100%）在开放性前路稳定术后在两个平面上均表现出正常的盂肱关节运动学。对于B组，14例患者中有12例（86%）在开放性肩袖修复术后在两个平面上均表现出正常的盂肱关节运动学。在A组，盂肱关节与肩胛胸壁运动关系的改变持续存在，而在B组这些关系变得正常。
