肩关节复发性脱位盂肱关节一致性与稳定性相关性研究

A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations

目的探讨肩关节复发性脱位患者盂肱关节一致性与稳定性的相关性。方法以2022年6月—2023年6月收治且符合选择标准的89例(89侧)肩关节复发性脱位患者作为研究对象。其中,男36例,女53例;年龄20~79岁,平均44岁。左肩40例,右肩49例。脱位2~6次,平均3次。采用Mimics 20.0软件基于CT扫描图像重建肱骨头及肩胛盂三维模型,测算肩胛盂轨迹(glenoid track,GT)、包容指数、嵌合指数、契合指数、Hill-Sachs间隙(Hill-Sachs interval,HSI),并判断on/off track程度(K值,即HSI与GT差值)。采用多重线性回归分析on/off track程度(K值)与包容指数、嵌合指数、契合指数之间的相关关系。结果多重线性回归分析示,K值与包容指数无相关(P>0.05),与嵌合指数、契合指数成正相关(P<0.05)。回归方程:K=–24.898+35.982×嵌合指数+8.280×契合指数,R2=0.084。结论肩关节复发性脱位中,肱骨头、肩胛盂骨性面积及曲率与肩关节稳定性相关。肱骨头骨性面积增大、肩胛盂骨性面积减小、肱骨头曲率增大、肩胛盂曲率减小是影响盂肱关节稳定性的危险因素。

Objective To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.Methods Eighty-nine patients(89 sides)with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects.There were 36 males and 53 females with an average age of 44 years(range,20-79 years).There were 40 cases of left shoulder and 49 cases of right shoulder.The shoulder joints dislocated 2-6 times,with an average of 3 times.The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images.The glenoid track(GT),inclusion index,chimerism index,fit index,and Hill-Sachs interval(HSI)were measured,and the degree of on/off track was judged(K value,the difference between HSI and GT).Multiple linear regression was used to analyze the correlation between the degree of on/off track(K value)and inclusion index,chimerism index,and fit index.Results Multiple linear regression analysis showed that the K value had no correlation with the inclusion index(P>0.05),and was positively correlated with the chimerism index and the fit index(P<0.05).Regression equation was K=–24.898+35.982×inclusion index+8.280×fit index,R 2=0.084.Conclusion Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations.Increased humeral head bony area,decreased scapular glenoid bony area,increased humeral head curvature,and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.