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Abstract：
Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. Methods: A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. Results: A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle (p-values 0.0019, <0.0001, and 0.0088, respectively). Conclusions: The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified.
摘要：
背景：反向全肩关节置换术（RSA）显著影响三角肌长度，紧张,和结构。研究已经广泛调查了三角肌特征的各种修改，如灌注，弹性,口径,组织学变化,RSA后的力量。然而,到目前为止,值得注意的是,目前尚无研究评估RSA手术后三角肌起源的骨矿物质密度(BMD)变化.方法：对2011年5月至2022年5月进行的一系列连续RSAs进行回顾性分析。纳入标准包括术前和最后一次随访的肩关节CT扫描和至少12个月随访的原发性RSA。使用快速感兴趣区域（ROI）方法计算以Hounsfield单位（HU）测量的小梁衰减。BMD分析涉及在每个患者的术前和术后CT扫描中分割三个ROI：肩峰，锁骨,和肩胛骨的脊柱。结果:43例患者共44个RSAs,由29名女性和14名男性组成，包括在这项研究中。平均随访时间为49±22.64个月。在所有分析区域的术前和术后HU值之间观察到显着差异。具体来说,肩峰和脊柱的骨密度增加，而在锁骨中下降（p值分别为0.0019，<0.0001和0.0088）。结论：肩关节生物力学的改变，因此,植入后的三角肌张力导致分析区域内骨质量的可辨别的变化。这项研究强调了彻底的术前患者计划的重要性。通过利用反向肩关节置换手术前常规获得的CT图像，肩峰骨折风险高的患者，锁骨,和肩胛骨脊柱可以识别。
