Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing
Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing
复制标题
DOI：
10.1016/s1058-2746(97)90084-7
复制
发表时间：
1997-11-01
影响因子：
3
通讯作者：
Altchek, DW
中科院分区：
文献类型：
--
作者：
Paletta, GA;Warner, JJP;Altchek, DW
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运动学和盂肱-肩胛胸运动关系，然后在手术前和手术修复及术后康复后确定肩关节前不稳定或肩袖撕裂患者的双平面盂肱运动学和盂肱-肩胛胸运动关系。在肩胛骨和水平（腋窝）平面上进行了一系列双平面X线摄影。通过这些影像，测量肱骨头和关节盂中心之间的关系，并测量盂肱和肩胛胸运动对总臂外展的贡献。6名正常成人接受X线评估，以建立正常对照值。Kappa分析用于确定技术的可靠性。术前研究了18名确认肩关节前不稳定的患者（A组）和15名确认肩袖撕裂的患者（B组）。A组18例患者中有7例（39%）和B组所有15例（100%）患者在肩胛平面外展过程中显示肱骨头上级平移。在水平面上，A组（不稳定）18例患者中有14例（78%）和B组（肩袖恐惧）无患者显示肩关节盂上肱骨头的异常前向平移。与正常对照组相比，两组均表现出盂肱-肩胛胸运动关系的改变。术后2年，A组12例患者和B组74例患者再次接受研究。所有这些患者在手术前都表现出肱骨头平移异常。对于A组，12例患者中的12例（100%）在开放式前稳定后在两个平面上显示出正常的盂肱运动学。对于B组，14例患者中有12例（86%）在开放性肩袖修复术后两个平面的盂肱运动学正常。在A组中，改变的盂肱-肩胛胸运动关系持续存在，而在B组中，这些关系变得正常。
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 fear) 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 74 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.