Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis
Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis
复制标题
DOI：
10.1016/j.jse.2019.03.008
复制
发表时间：
2019-10-01
影响因子：
3
通讯作者：
Jinzaki, Masahiro
中科院分区：
文献类型：
--
作者：
Matsumura, Noboru;Oki, Satoshi;Jinzaki, Masahiro
背景：尽管肩关节不稳很常见，但其机制尚不清楚。本研究的目的是利用四维CT扫描对主动外旋加外展治疗的肩周炎患者进行定量评估。方法：前瞻性研究10例支点试验阳性的单侧肩周炎患者。在肩外展90度主动外旋的情况下，以5帧/秒的速度进行6秒的双侧肩关节顺序CT扫描。分别在0度、20度、40度、60度和最大肩外展-外旋起始位置下计算肱骨头中心在前后、上下和内侧方向的三维位置。结果：肩关节外旋时，肩关节向后、向下、内侧移位，患侧与健侧肩关节位置的差异。但患侧与对侧相比，后平移明显减少(P=.028)，下平移显著增加(P=.047)，内侧平移明显减少(P=.037)。结论：主动肩外展外旋时，肩关节下韧带前束功能障碍导致肱骨头后平移减少，下平移增加，内侧平移减少。(C)《2019年肩肘外科杂志》董事会。版权所有。
Background: Although glenohumeral instability is common, the mechanism of instability remains unclear. The purpose of this study was to quantitatively evaluate humeral head translation during active external rotation with abduction in patients with glenohumeral instability by use of 4-dimensional computed tomography scans.Methods: Ten patients with unilateral glenohumeral instability with a positive fulcrum test were prospectively included in this study. Sequential computed tomography of bilateral shoulders during active external rotation at 90 degrees of shoulder abduction was performed for 6 seconds at 5 frames per second. The 3-dimensional positions of the humeral head center in the anteroposterior, superoinferior, and mediolateral directions were calculated at 0 degrees, 20 degrees, 40 degrees, 60 degrees, and maximum shoulder abduction-extemal rotation from the starting position. Translation of the humeral head center from the starting position was evaluated using Dunnett multiple-comparison tests, and the differences between the affected and intact shoulders were assessed using Wilcoxon signed rank tests.Results: The humeral head center translated posteriorly, inferiorly, and medially during glenohumeral external rotation with the shoulder in the abducted position on the intact side. However, the affected humeral head showed significantly less posterior translation (P = .028), greater inferior translation (P = .047), and less medial translation (P = .037) than the contralateral side.Conclusions: This study indicated that dysfunction of the anterior band of the inferior glenohumeral ligament causes decreased posterior, increased inferior, and decreased medial translation of the humeral head during active shoulder abduction external rotation. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.