反式全肩关节置换术中盂球偏移对肩关节活动度的影响:一项标准化计算机模型的研究

Effects of glenosphere offsets on impingement-free range of motion in reverse total shoulder arthroplasty:a standardized computer simulation study

目的探讨反式全肩关节置换术(RTSA)中盂球偏移对肩关节无撞击活动度的影响。方法利用6例原发性骨关节炎患者的肩关节断层扫描重建出肩关节模型,按照标准的手术操作虚拟行RTSA并模拟肩部活动。分别构建2种盂球侧向偏移(0、4 mm)和6种位置偏移(中心、向下、向后、向前、前下和后下)的反式肩关节模型。评估外展-内收、屈伸、总旋转(内旋和外旋的总和)和总体活动(所有运动模式中,肩关节活动范围的总和)的无撞击活动度及撞击位置。结果12种不同盂球偏移的组合在所有运动中均达到了原始肩关节活动范围的50%。在0、4 mm侧向偏移的外展-内收运动中,盂球前下偏移的活动范围均为最大(分别为94.4°±8.7°和105.3°±6.9°),而各位置间差异无统计学意义(P>0.05)。在0、4 mm侧向偏移的屈伸活动中,后下偏移的活动范围均为最大(分别为194.1°±6.9°和196.9°±9.7°),而各位置间差异均无统计学意义(P>0.05)。在0、4 mm侧向偏移的总旋转活动中,前下偏移的活动范围均为最大(分别为141.5°±5.9°和160.6°±8.5°),较中心、向前和向后偏移具有显著优势,差异有统计学意义(P<0.05),而与向下和向后下偏移差异无统计学意义(P>0.05)。在总体活动中,前下偏移的活动范围均为最大,当侧移为0 mm,前下偏移活动范围(421.8°±16.4°)较中心和向后偏移具有显著优势,差异有统计学意义(P<0.05)。与盂球侧向偏移0 mm相比,侧移4 mm显著改善了肩关节的总旋转(122.8°±10.6°vs.145.8°±4.8°)和总体活动范围(390.9°±11.6°vs.428.4°±19.8°),差异均有统计学意义(P<0.05)。结论盂球向前下、向下和向后下偏移均可改善各运动模式的活动范围。盂球的位置和侧向偏移对肩关节的总旋转和总体活动有明显影响。盂球前下和向下偏移较中心位置在总旋转和总体活动方面具有显著的优势。

Objective To compare the effects of glenosphere offset positions on the impingement-free range of motion(ROM)in reverse total shoulder arthroplasty(RTSA).Methods Shoulder joint models were reconstructed using shoulder CT scans of 6 patients with primary osteoarthritis.RTSA was performed virtually according to standard surgical procedures,and shoulder movements were simulated.Reverse shoulder models were constructed with 2 lateral offsets(0 and 4 mm)and 6 positional offsets(center,inferior,posterior,anterior,anterior-inferior,and posterior-inferior).The impingement-free ROM and impingement sites for abduction-adduction,flexion-extension,total rotation(sum of internal and external rotation),and total ROM(sum of ROM in all movement modes)were evaluated.Results All the 12 combinations of different glenosphere offsets achieved 50%of the original shoulder ROM in all movements.In the abduction-adduction motion with 0 and 4 mm lateral offsets,the anterior-inferior offset provided the largest ROM(94.4°±8.7°and 105.3°±6.9°,respectively),but there was no significant difference between the positions(P>0.05).In the flexion-extension motion with 0 and 4 mm lateral offsets,the posterior-inferior offset showed the largest ROM(194.1°±6.9°and 196.9°±9.7°,respectively),but there was no significant difference between the positions(P>0.05).In the total rotation motion with 0 and 4 mm lateral offsets,the anterior-inferior offset had the largest ROM(141.5°±5.9°and 160.6°±8.5°,respectively),showing significant advantages over the center,anterior,and posterior offsets(P<0.05),but insignificant advantages over the inferior and posterior-inferior offsets(P>0.05).In total ROM,the anterior-inferior offset provided the largest ROM.When the lateral offset was 0 mm,the anterior-inferior offset provided a ROM of 421.8°±16.4°,showing significant advantages over the center and posterior offsets(P<0.05).Compared with the lateral glenosphere offset of 0 mm,the lateral glenosphere offset of 4 mm significantly improved total shoulder ROM(122.8°±10.6°versus 145.8°±4.8°)and total ROM(390.9°±11.6°versus 428.4°±19.8°)(P<0.05).Conclusions The anterior-inferior,inferior,and posterior-inferior glenosphere offsets can improve ROM in all movement patterns.The position and lateral offset of the glenosphere significantly affect the total rotation and total ROM of the shoulder joint.Specifically,the anterior-inferior and inferior offsets show significant advantages over the center position in total rotation and total ROM of the shoulder joint.