Warner J J, Bowen M K, Deng X H, Hannafin J A, Arnoczky S P, Warren R F
Department of Orthopaedic Surgery, University of Pittsburgh, USA.
J Shoulder Elbow Surg. 1998 Jul-Aug;7(4):381-8. doi: 10.1016/s1058-2746(98)90027-1.
The purpose of this study was to determine the articular contact patterns of the normal glenohumeral joint, and to correlate these findings with cartilage and subchondral bone architecture. We studied 10 normal shoulders of cadavers. We removed all soft tissues except the joint capsule and rotator cuff and then placed the shoulders on a testing apparatus that allowed freedom of translation in three planes. After the humerus was placed in a neutral position of rotation, articular contact patterns were measured with specially prepared prescale Fuji film so that it could be inserted between the joint surfaces. Articular contact was analyzed with 222 and 444 N of joint compressive load, and the humerus was positioned in scapular plane abduction of 0 degree, 45 degrees, and 90 degrees. The contact patterns were then digitized to determine percentage contact of the humeral head on the glenoid. We studied 12 additional cadaver shoulders with fine microradiographs and histologic techniques after we sectioned the glenoids in the anterior-posterior and superior-inferior planes. We then analyzed articular and subchondral architecture. We found that when the shoulder was adducted the contact area of the humeral head on the glenoid was limited to the anatomic region of the central glenoid known as the "bare area." This was histologically and radiographically an area of cartilage thinning and increased subchondral bone density. As the shoulder was abducted the articular congruity and percentage contact area increased. We concluded that there was a slight articular mismatch with the shoulder adducted in the normal shoulder. Histologic and radiographic studies suggested that the central bare area region of the glenoid was a region of increased compressive loading. As the shoulder was abducted the joint became more congruent and thus the contact area of the humeral head on the glenoid increased.
本研究的目的是确定正常盂肱关节的关节接触模式，并将这些发现与软骨和软骨下骨结构相关联。我们研究了10具尸体的正常肩部。我们去除了除关节囊和肩袖之外的所有软组织，然后将肩部放置在一个允许在三个平面自由平移的测试装置上。在将肱骨置于旋转中立位后，用特制的预缩放富士胶片测量关节接触模式，以便将其插入关节面之间。在222 N和444 N的关节压缩负荷下分析关节接触情况，并且将肱骨置于肩胛平面外展0度、45度和90度的位置。然后将接触模式数字化，以确定肱骨头在肩胛盂上的接触百分比。在我们将肩胛盂沿前后平面和上下平面切开后，我们用精细的微放射照片和组织学技术研究了另外12具尸体的肩部。然后我们分析了关节和软骨下结构。我们发现，当肩部内收时，肱骨头在肩胛盂上的接触区域局限于肩胛盂中央被称为“裸区”的解剖区域。从组织学和放射学角度来看，这是一个软骨变薄且软骨下骨密度增加的区域。随着肩部外展，关节的一致性和接触面积百分比增加。我们得出结论，在正常肩部中，肩部内收时存在轻微的关节不匹配。组织学和放射学研究表明，肩胛盂的中央裸区是压缩负荷增加的区域。随着肩部外展，关节变得更加一致，因此肱骨头在肩胛盂上的接触面积增加。
