Effect of implant geometry on range of motion in reverse shoulder arthroplasty assessed using glenohumeral separation distance
Effect of implant geometry on range of motion in reverse shoulder arthroplasty assessed using glenohumeral separation distance
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DOI：
10.1016/j.jse.2014.12.031
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发表时间：
2015-09-01
影响因子：
3
通讯作者：
Bicknell, Ryan T.
中科院分区：
文献类型：
--
作者：
North, Lydia R.;Hetzler, Markus A.;Bicknell, Ryan T.
背景：虽然反向肩关节置换术已成功治疗袖带撕裂关节病患者，但手术后植入物撞击通常会导致并发症，包括运动范围缩小、骨质流失和不稳定。在体外模拟这个问题的尝试通常依赖于主观视觉方法来检测撞击。本研究的目的是使用植入物跟踪方法进行撞击检测，确定肱骨颈干角度、植入物直径、肱骨杯深度和关节盂组件偏心率对最小外展角度和运动范围的影响。方法：在运动肩模拟器中进行测试，并使用代表三角肌的驱动电缆。手动将肱骨内收并外展至任一方向的撞击点。通过光学运动捕捉来跟踪植入部件的中心，并使用阈值算法进行处理，以确定发生撞击的最小外展角。结果：肱骨杯深度对最小外展角和运动范围影响最大，固定杯使运动范围减少了 26 度。颈轴角减小使最小外展角减少了 10 度，但对整体运动范围影响不大。直径和偏心率影响不大。结论：减小颈轴角度会减小最小外展角度，但不会改善整体运动范围。保持力更强的肱骨杯可显着增加最小外展角。尽管保持杯旨在提高关节稳定性，但它们赋予关节的运动范围减小可能会部分抵消增加约束的好处。 (C) 2015 年肩肘外科杂志董事会。
Background: Whereas reverse shoulder arthroplasty has been successful in treating patients with cuff tear arthropathy, implant impingement after the procedure often causes complications, including reduced range of motion, bone loss, and instability. Attempts to simulate this problem in vitro typically rely on subjective visual methods to detect impingement. The purpose of this study was to determine the effect of humeral neck-shaft angle, implant diameter, humeral cup depth, and glenoid component eccentricity on minimum abduction angle and range of motion using an implant-tracking method for impingement detection.Methods: Tests were performed in a kinematic shoulder simulator with actuated cables representing the deltoid. The humerus was manually adducted and abducted past the point of impingement in either direction. Centers of the implant components were tracked with optical motion capture and processed with a thresholding algorithm to determine the minimum abduction angle where impingement occurred.Results: Humeral cup depth had the largest effect on minimum abduction angle and range of motion, with a retentive cup reducing range of motion by 26 degrees. A decreased neck-shaft angle reduced minimum abduction angle by 10 degrees but had little effect on overall range of motion. Diameter and eccentricity had little effect.Conclusion: A reduced neck-shaft angle reduces minimum abduction angle but does not improve overall range of motion. A more retentive humeral cup increases minimum abduction angle significantly. Although retentive cups are intended to improve joint stability, the reduced range of motion that they impart to the joint may partly counteract the benefits of increased constraint. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.