Mihir Sheth MD , Raymond Kitziger BSA , Anup A. Shah MD
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引用次数: 0
Abstract
Background
Functional internal rotation (fIR) can be limited after reverse shoulder arthroplasty (RSA) and can result in difficulties performing activities of daily living (ADLs). The goal of this narrative review is to summarize the growing body of research on optimizing fIR after RSA that may be useful to clinical practice.
Methods
A narrative review of recent literature on IR after RSA.
Results
IR required for ADLs is a compound motion involving multiple joints and planes; for this reason, the term “functional internal rotation” can be used to differentiate this motion from glenohumeral IR. Measuring IR by vertebral level is limited by interobserver reliability and poor correlation with the ability to perform ADLs. IR-specific scores or questions may be more relevant. Patient-based factors that influence IR include body mass index, thoracic spine sagittal alignment, humeral torsion, preoperative humerothoracic extension, and scapulothoracic mobility. Surgically, a healed subscapularis repair appears to improve IR and anterior latissimus dorsi transfers have been described with favorable results. Tools to predict IR after RSA are emerging and may be helpful to counseling patients on implant selection.
Conclusion
FIR after RSA is optimized by maximizing impingement-free arc of motion and subscapularis repair in patients with mobile scapulothoracic joints, adequate preoperative humerothoracic extension, and low body mass index.
背景反向肩关节置换术(RSA)后,功能性内旋(fIR)可能会受到限制,导致日常生活活动(ADL)困难。本综述旨在总结反向肩关节置换术(RSA)后不断增加的有关优化功能性内旋的研究,这些研究可能对临床实践有用。结果ADLs所需的内旋是一种涉及多个关节和平面的复合运动;因此,可以使用 "功能性内旋 "一词来区分这种运动与盂肱关节内旋。按椎骨水平测量内旋受到观察者间可靠性的限制,而且与日常活动能力的相关性较差。针对 IR 的评分或问题可能更有意义。影响IR的患者因素包括体重指数、胸椎矢状排列、肱骨扭转、术前肱胸伸展以及肩胛胸活动度。在手术方面,愈合的肩胛下肌修复似乎可以改善IR,背阔肌前移也取得了良好的效果。结论对于肩胛胸关节可活动、术前肱骨胸廓有足够伸展且体重指数较低的患者,通过最大化无撞击运动弧度和肩胛下肌修复,可优化RSA术后的IR。