Reverse total shoulder arthroplasty component center of rotation affects muscle function
Reverse total shoulder arthroplasty component center of rotation affects muscle function
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DOI：
10.1016/j.jse.2013.11.025
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发表时间：
2014-08-01
影响因子：
3
通讯作者：
D'Lima, Darryl D.
中科院分区：
文献类型：
--
作者：
Hoenecke, Heinz R., Jr.;Flores-Hernandez, Cesar;D'Lima, Darryl D.
背景：盂肱旋转中心的内侧化会改变三角肌的力臂，会影响肌肉功能，并增加因撞击而导致肩胛骨切迹的风险。本研究的目的是确定盂球位置对三角肌效率和盂肱内收范围的影响。方法：通过计算机断层扫描重建肩胛骨模型，并虚拟植入初次或反向全肩关节置换术植入物。改变盂肱关节的位置，以模拟不同程度的“内侧化”和相对于关节盂的下位。在 OpenSim 肌肉骨骼建模软件中计算肩部外展期间的肌肉和关节力。结果：初次全肩关节置换术的平均盂肱关节反作用力与先前报道的体内水平相差 5% 以内。盂球的优越位置或完全侧化通过以下方式增加了盂肱关节反作用力：相对于推荐的反向全肩关节置换术位置，三角肌的力臂在推荐的基线手术位置处分别为 10% 和 18%。 基线盂肱关节内收缺陷平均超过 10 度，当盂肱关节处于上方时，盂肱内收缺陷会增加到超过 25 度。讨论/结论：选择盂球的最佳位置需要权衡植入物-骨界面处的弯矩、撞击风险和三角肌效率。一个可行的选择是部分内侧化盂球，这保留了三角肌效率的大部分优点并降低了肩胛骨切迹的风险 (C) 2014 年肩肘外科董事会杂志。
Background: Medialization of the glenohumeral center of rotation alters the moment arm of the deltoid, can affect muscle function, and increases the risk for scapular notching due to impingement. The objective of this study was to determine the effect of position of the glenosphere on deltoid efficiency and the range of glenohumeral adduction.Methods: Scapulohumeral bone models were reconstructed from computed tomography scans and virtually implanted with primary or reverse total shoulder arthroplasty implants. The placement of the glenosphere was varied to simulate differing degrees of "medialization'' and inferior placement relative to the glenoid. Muscle and joint forces were computed during shoulder abduction in OpenSim musculoskeletal modeling software.Results: The average glenohumeral joint reaction forces for the primary total shoulder arthroplasty were within 5% of those previously reported in vivo. Superior placement or full lateralization of the glenosphere increased glenohumeral joint reaction forces by 10% and 18%, respectively, relative to the recommended reverse total shoulder arthroplasty position. The moment arm of the deltoid muscle was the highest at the recommended baseline surgical position. The baseline glenosphere position resulted in a glenohumeral adduction deficit averaging more than 10 degrees that increased to more than 25 degrees when the glenosphere was placed superiorly. Only with full lateralization was glenohumeral adduction unaffected by superoinferior placement.Discussion/Conclusion: Selecting optimum placement of the glenosphere involves tradeoffs in bending moment at the implant-bone interface, risk for impingement, and deltoid efficiency. A viable option is partially medializing the glenosphere, which retains most of the benefits of deltoid efficiency and reduces the risk for scapular notching. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.