Decreasing glenoid inclination improves function in shoulders with simulated, massive rotator cuff tears
Decreasing glenoid inclination improves function in shoulders with simulated, massive rotator cuff tears
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DOI：
10.1016/j.clinbiomech.2006.04.013
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发表时间：
2006-11-01
影响因子：
1.8
通讯作者：
Debski, Richard E.
中科院分区：
文献类型：
--
作者：
Konrad, Gerhard G.;Markmiller, Max;Debski, Richard E.
背景肩袖大面积撕裂导致肩关节功能差，表现为盂肱外展减少和肱骨头相对于正常位置的上级平移。关节盂的倾斜角度与肩袖撕裂有关。本研究的目的是量化肩关节主动外展过程中，肩盂倾角减小对盂肱运动学的影响，模拟肩袖大面积撕裂。八个新鲜冷冻的全上肢进行了测试，使用动态肩部测试装置。在记录了完整肩关节的运动学之后，手术模拟了一个巨大的肩袖撕裂。然后进行关节盂截骨术，倾斜角减小30度。记录外展过程中肱骨头的平移和最大外展角。肩袖完整时，肱骨头在关节盂上的平移最小，最大外展角平均为85.5度（SD 7.4度）。肩袖大面积撕裂导致肱骨头上级平移，撞击肩峰。最大外展角平均为15.5度（SD 9.4度）。减小关节盂的倾斜角度可显著减少外展过程中的上级肱骨头平移，并且不会撞击肩峰。达到的最大外展平均为28.5度（SD 17.0度）。从临床角度来看，减少上级平移可能会减少肩关节疼痛，因为肱骨头不再撞击肩峰。有必要进行进一步的调查，以评估外展的改善是否具有临床意义。(c)2006爱思唯尔有限公司保留所有权利。
Background. A massive rotator cuff tear lead's to poor shoulder function as evidenced by diminished glenohumeral abduction and superior translation of the humeral head compared to its normal position. The inclination angle of the glenoid has been associated with rotator cuff tears. The objective of this study was to quantify the effect of a decreased glenoid inclination angle on glenohumeral kinematics during active abduction in shoulders with a simulated, massive rotator cuff tear.Methods. Eight fresh-frozen full upper extremities were tested using a dynamic shoulder testing apparatus. After recording the kinematics of the intact shoulder, a massive rotator cuff tear was surgically simulated. An osteotomy of the glenoid was then performed and the inclination angle was decreased by 30 degrees. The translation of the humeral head during abduction and the maximum abduction angle were recorded.Findings. With an intact rotator cuff minimal humeral head translation on the glenoid occurred and the maximum abduction angle was mean 85.5 degrees (SD 7.4 degrees). A massive rotator cuff tear resulted in superior translation of the humeral head with impingement on the acromion. The maximum abduction angle was mean 15.5 degrees (SD 9.4 degrees). Decreasing the inclination angle of the glenoid resulted in a significant reduction of superior humeral head translation during abduction and there was no impingement on the acromion. The maximum abduction achieved was mean 28.5 degrees (SD 17.0 degrees).Interpretation. From a clinical perspective the reduced superior translation may decrease shoulder pain since the humeral head no longer impinges on the acromion. Further investigations are necessary to assess if the improvement in abduction is clinically significant. (c) 2006 Elsevier Ltd. All rights reserved.