Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: A cadaver study
Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: A cadaver study
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DOI：
10.1016/j.otsr.2013.08.008
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发表时间：
2013-12-01
影响因子：
2.3
通讯作者：
Favard, L.
中科院分区：
文献类型：
--
作者：
Berhouet, J.;Garaud, P.;Favard, L.
背景：反向肩关节置换术的一个共同缺点是手臂旋转范围的限制。假体的设计和植入技术已经被建议进行一些改变以提高旋转活动范围(ROM)。假设：肩臼组件的设计和肱骨组件的倒置程度影响反向肩关节成形术后的旋转活动范围。材料和方法：40例身体肩关节植入了AequalsReverted(TM)假体(Tornier公司，Edina，MN，USA)。共测试了8种关节镜组件组合，其中5种为36 mm球体(中心座椅、偏心座椅、下倾，中心有5 mm厚的侧向间隔物，中心有7 mm厚的侧向间隔物)，3种是42 mm球体(中心无间隔物、7 mm或10 mm间隔物)。采用0度、10度、20度、30度、40度后倾角评价肱骨假体位置。结果：较大的肾小球(42 Mm)与较大的旋转ROMs显著相关(P<；0.05)，特别是当结合侧向间隔物时(内旋转46°，外旋转66°)。36 mm球体的旋转只读存储器最小。内旋减少和外旋显著增加(P<；0.05)与较大的肱骨假体后倾有关。在本研究中，旋转ROMS之间的平衡达到最佳，在本研究中，旋转ROMS的平均角度为17.5度。讨论：我们在大量身体上的解剖学研究涉及到详细且可重复性的实验方案。然而，我们没有评估肩胛骨解剖的可变性。早期关于技术参数的影响的研究没有考虑到肱骨成分的后退。结论：通过使用大直径的肾小球和间隔物使肾盂-肱骨关节的旋转中心偏侧，以及通过将肱骨部件定位在患者的天然后倾值，可以改善旋转的ROM值。(C)2013年爱思唯尔·马森公司。版权所有。
Background: A common disadvantage of reverse shoulder arthroplasty is limitation of the range of arm rotation. Several changes to the prosthesis design and implantation technique have been suggested to improve rotation range of motion (ROM).Hypothesis: Glenoid component design and degree of humeral component retroversion influence rotation ROM after reverse shoulder arthroplasty.Material and methods: The Aequalis Reversed (TM) shoulder prosthesis (Tornier Inc., Edina, MN, USA) was implanted into 40 cadaver shoulders. Eight glenoid component combinations were tested, five with the 36-mm sphere (centred seating, eccentric seating, inferior tilt, centred with a 5-mm thick lateralised spacer, and centred with a 7-mm thick lateralised spacer) and three with the 42-mm sphere (centred with no spacer or with a 7-mm or 10-mm spacer). Humeral component position was evaluated with 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees of retroversion. External and internal rotation ROMs to posterior and anterior impingement on the scapular neck were measured with the arm in 20 degrees of abduction.Results: The large glenosphere (42 mm) was associated with significantly (P < 0.05) greater rotation ROMs, particularly when combined with a lateralised spacer (46 degrees internal and 66 degrees external rotation). Rotation ROMs were smallest with the 36-mm sphere. Greater humeral component retroversion was associated with a decrease in internal rotation and a significant increase (P < 0.05) in external rotation. The best balance between rotation ROMs was obtained with the native retroversion, which was estimated at 17.5 degrees on average in this study.Discussion: Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. However, we did not evaluate the variability in scapular anatomy. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. In addition, no previous studies assessed rotation ROMs.Conclusion: Rotation ROM should be improved by the use of a large-diameter glenosphere witha spacer to lateralise the centre of rotation of the gleno-humeral joint, as well as by positioning the humeral component at the patient's native retroversion value. (C) 2013 Elsevier Masson SAS. All rights reserved.