Effects of prosthesis design and placement on shoulder kinematics and strength after reverse shoulder arthroplasty

项目摘要/摘要 反向肩关节置换术(RSA)是一种最常在老年患者身上进行的外科手术 由于不可修复的肩袖撕裂而不能抬起手臂的有症状的肩关节炎。之前 对于手术，患者可能会出现假性瘫痪，严重限制了他们独立执行任务的能力。 日常生活活动(ADL)。RSA通过允许恢复力量和运动范围(ROM) 三角肌以弥补肩袖的缺失。然而，RSA术后的临床结果总体上是有利的， 并发症发生率仍然很高，功能结果(如活动范围和力量)仍处于次优状态。 对身体的研究和计算机模拟表明，通过 修改肩部假体的设计和放置。然而，对于最好的选择，仍然存在争议 RSA术后最大化肩关节功能的种植体构型和植入技术。这场争论 持续存在，在很大程度上是由于缺乏定量的体内运动数据来指导这场辩论。因此，a RSA患者迫切需要定量的活体肩部运动。我们研究的长期目标是 是为了改善接受RSA治疗的患者的临床和功能结果。该项目的目标是：1) 确定假体设计和放置对RSA术后肩部运动和力量的影响，以及2) 确定与改善临床结果相关的运动和力量参数。参与者 将有30名RSA患者在术后1至5年内接受治疗。我们将使用双平面摄影对肩部进行成像。 当受试者进行肩关节平面外展时的运动，90外展时的内/外旋转， 触碰后脑勺，触碰下背部中部。经过验证的跟踪系统，具有 平移和旋转的精确度分别为1 mm和1将决定肩部关节的运动。 有动静。肩部力量将在屈曲/伸展时使用等速测力法进行测量， 内/外旋转，和ab/内收。具体目的是确定假体的体内效应。 RSA术后肩部运动学和力量的放置和设计，并识别肩部运动学 以及与改善临床结果相关的强度参数。作为二次分析的一部分， 我们将确定关节球和肩窝之间接触区域的大小和位置，以 描述假体的机械环境，以及肩窝和肩窝之间的距离 肩胛骨可以识别可能导致肩胛骨凹陷的活体运动。这项研究的预期结果将 将假体放置和设计与活体肩功能和术后临床结果联系起来的新数据 RSA。这些知识可用于改善临床和功能结果，从而提高 RSA患者的生活。这项研究将提供初步的数据，为未来的研究提供参考，以调查这些影响 年龄、合并症和康复对肩关节运动学、力量和RSA术后临床结果的影响。

Project Summary/Abstract Reverse shoulder arthroplasty (RSA) is a surgical procedure most often performed on elderly patients with symptomatic shoulder arthritis who are unable to elevate their arm due to an irreparable rotator cuff tear. Prior to surgery, patients may have pseudoparalysis that severely limits their ability to independently perform common activities of daily living (ADLs). RSA restores strength and range of motion (ROM) by allowing the deltoid to compensate for an absent rotator cuff. Clinical outcomes after RSA are generally favorable, however, complication rates remain high and functional outcomes (e.g. range of motion and strength) remain suboptimal. Research on cadavers and computer simulations suggest that functional outcomes may be improved by modifying the design and placement of the shoulder prosthesis. However, controversy still exists as to the best implant geometry and implantation technique for maximizing shoulder function after RSA. This controversy persists, in large part, due to the paucity of quantitative in vivo motion data to guide this debate. Therefore, a critical need exists for quantitative in vivo shoulder motion in RSA patients. The long-term goal of our research is to improve clinical and functional outcomes for patients who receive RSA. The goals of this project are: 1) to identify the effects of prosthesis design and placement on shoulder motion and strength after RSA, and 2) to identify the motion and strength parameters that are associated with improved clinical outcomes. Participants will be 30 RSA patients who are 1 to 5 years post-surgery. We will use biplane radiography to image shoulder motion while participants perform scapular plane abduction, internal/external rotation at 90 abduction, touching the back of the head, and touching the middle of the lower back. A validated tracking system that has a precision of better than 1 mm in translation and 1 in rotation will determine shoulder joint motion during each movement. Shoulder strength will be measured using isokinetic dynamometry during flexion/extension, internal/external rotation, and ab/adduction. The Specific Aims are to determine the in vivo effect of prosthesis placement and design on shoulder kinematics and strength after RSA, and to identify the shoulder kinematics and strength parameters that are associated with improved clinical outcomes. As part of a secondary analysis, we will determine the size and location of the contact region between the glenosphere and humerosocket to characterize the mechanical environment of the prosthesis, and the distance between the humerosocket and scapula to identify in vivo motions that may lead to scapular notching. The expected outcome of this study will be novel data relating prosthesis placement and design to in vivo shoulder function and clinical outcomes after RSA. This knowledge can be used to improve clinical and functional outcomes, leading to improved quality of life for RSA patients. This study will provide preliminary data to inform future studies to investigate the effects of age, comorbidities, and rehabilitation on shoulder kinematics, strength and clinical outcomes after RSA.