■在反向肩关节成形术(RSA)中,基板侧向化(BL)的理想组合,卵球尺寸(GS),和关节囊球悬垂(GOH)与常用的145°颈轴角(NSA)尚不清楚。这是第一项评估身高(BH)相关性的研究,肱骨头大小(HS),关节盂高度(GH),以及性别与最佳关节盂配置的关联,以保持运动范围(ROM)的解剖侧向(aLAT),以优化145°和较小的135°RSA的肌肉长度。
■在这个计算机模型研究中,分析了22例没有关节狭窄的计算机断层摄影(11例男性/女性)。标准化的半镶嵌145°平台杆与20个关节盂配置组合(基板[B]25,25+3/+6侧向化[l],29,29+3/6l与鼓膜球36,36+2偏心[e]结合,36+3l,39,39+3e,39+3l,42,42+4e)。绑架-内扣,屈伸,外部旋转-内部旋转,总ROM(TROM),并计算了总缺口相关(TNR)ROM,最佳的TROM型号尊重ALAT(-1mm至+1mm)和HS/GH记录。第二,145°模型(AscendFlex茎;Stryker,卡拉马祖,MI,美国)进行了转换,并与135°镶嵌RSA(新执行茎;斯特莱克,卡拉马祖,MI,美国)保持GOH(6.5-7毫米)和aLAT。
■最佳145°模型具有偏心卵球(平均BL:3.5毫米,GOH8.8毫米,GS38.1毫米,扩张23毫米)。135°模型具有同心的关节球,平均BL3.8毫米,GOH6.9mm,GS39.7毫米,和远端14.1毫米。在145°和135°模型中,HS与BL的正相关最强(0.65/0.79)。尽管135°NSA的较小女性的GOH减少,内收,外部旋转,扩展,TNRROM,和TROM显着增加(P=.02,P=.005,P=.005,P=.004,P=.003),然而,外展减少(P=0.02)。男性也有同样的趋势。
■HS是手术或术前的实用措施,与BL的强正相关是一个有用的计划辅助工具。尽管减少了GOH,转换到较小的135°NSAinlay设计对于维持甚至显着增加小女性的TNRROM(延伸/外部旋转/内收)的所有组件非常强大,但外展减少的缺点可以通过肩胛骨运动来补偿。横向与较小的135°RSA优化肌肉长度,可能有助于肩胛骨下修复,并保持最高的刚体运动。
UNASSIGNED: In reverse shoulder arthroplasty (RSA), the ideal combination of baseplate lateralization (BL), glenosphere size (GS), and glenosphere overhang (GOH) with a commonly used 145° neck shaft angle (NSA) is unclear. This is the first
study evaluating correlations of body height (BH), humeral head size (HS), glenoid height (GH), and association of gender with best glenoid configurations for range of motion (ROM) maintaining anatomic lateralization (aLAT) for optimized muscle length in 145° and less distalized 135° RSA.
UNASSIGNED: In this computer model
study, 22 computed tomographies without joint narrowing were analyzed (11 male/female). A standardized semi-inlay 145° platform stem was combined with 20 glenoid configurations (baseplate [B] 25, 25 + 3/+6 lateralized [l], 29, 29 + 3/6l combined with glenosphere 36, 36 + 2 eccentric [e], 36 + 3l, 39, 39 + 3e, 39 + 3l , 42, 42 + 4e). Abduction-adduction, flexion-extension, external rotation-internal rotation, total ROM (TROM), and total notching relevant (TNR) ROM were computed, best TROM models respecting aLAT (-1 mm to +1 mm) and HS/GH recorded. Second, the 145° models (Ascend Flex stem; Stryker, Kalamazoo, MI, USA) were converted and compared to a 135° inlay RSA (New Perform stem; Stryker, Kalamazoo, MI, USA) maintaining GOH (6.5-7 mm) and aLAT.
UNASSIGNED: Best 145° models had eccentric glenospheres (mean BL: 3.5 mm, GOH 8.8 mm, GS 38.1 mm, distalization 23 mm). The 135° models had concentric glenospheres, mean BL 3.8 mm, GOH 6.9 mm, GS 39.7 mm, and distalization 14.1 mm. HS showed the strongest positive correlation with BL in 145° and 135° models (0.65/0.79). Despite reduced GOH in smaller females with a 135° NSA, adduction, external rotation, extension, TNR ROM, and TROM were significantly increased (P = .02, P = .005, P = .005, P = .004, P = .003), abduction however reduced (P = .02). The same trends were seen for males.
UNASSIGNED: HS is a practical measure in surgery or preoperatively, and the strong positive correlation with BL is a useful planning aid. Despite reduction of GOH, conversion to a less distalized 135° NSAinlay design is powerful to maintain and even significantly increase all components of TNR ROM (extension/external rotation/adduction) in small females with the drawback of reduced abduction which may however be compensated by scapula motion. Lateralization with a less distalized 135° RSA optimizes muscle length, may facilitate subscapularis repair, and maintains highest rigid body motion.