IF 2.9 2区 医学 Q1 ORTHOPEDICS Journal of Shoulder and Elbow Surgery Pub Date : 2025-02-13 DOI:10.1016/j.jse.2024.12.049
Cole T Fleet, Patrick Carroll, James A Johnson, George S Athwal
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引用次数: 0

摘要

背景:反向全肩关节成形术(rTSA)中聚乙烯衬垫的限制会影响盂肱关节的稳定性。然而,其对盂肱关节活动范围(ROM)的影响仍不清楚。因此,本研究的目的是确定在rTSA术后依次增加聚乙烯衬垫约束对无撞击ROM的影响。此外,这些依次增加的约束设计还与不同的肱骨颈轴角度(NSA)、盂直径和称为聚乙烯边缘宽度的新变量一起进行了评估:对 20 具上肢尸体进行计算机断层扫描,并通过手动分割制作出肩胛骨和肱骨的三维模型。然后为每个模型虚拟植入一个通用的 rTSA 植入体。评估了九种不同的聚乙烯约束比(定义为聚乙烯深度和聚乙烯半径之间的比率;数值范围为 0.35-0.75,增量为 0.05),以及三种 NSA(135°、145° 和 155°)、三种盂直径(36mm、39mm 和 42mm)和四种聚乙烯边缘宽度(1mm、2mm、3mm 和 4mm)。由此产生了 108 种不同的聚乙烯设计和 324 种不同的 rTSA 设计。将所有虚拟植入的骨骼模型作为刚体导入定制的运动软件,在该软件中进行了六种标准运动(外展、内收、前倾、外展、内旋和外旋),然后评估了全周 ROM。每个动作中的撞击都会被自动检测出来。然后对每种植入体结构和运动路径的最大无撞击ROM进行量化和统计评估:结果:在所有模拟运动中,聚乙烯约束、聚乙烯边缘宽度、NSA和胶圈直径都会显著影响无撞击ROM(PD讨论):在所有评估运动中,聚乙烯约束的增加都会明显降低无撞击 ROM。然而,聚乙烯约束对盂肱伸展、内收、内旋、外旋和全周运动的影响最大。研究还发现,聚乙烯边缘宽度对所有运动的无撞击ROM都有显著影响。由于聚乙烯衬垫对rTSA生物力学、关节稳定性和ROM的影响,因此还需要进一步研究来确定聚乙烯衬垫约束在rTSA中的最佳值。
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The Effect of Sequentially Increased Polyethylene Constraint on Impingement in Reverse Shoulder Arthroplasty: A Biomechanical Investigation.

Background: The constraint of the polyethylene liner in reverse total shoulder arthroplasty (rTSA) can affect glenohumeral joint stability. However, its influence on glenohumeral range of motion (ROM) remains unclear. Therefore, it was the objective of this study to determine the effect of sequentially increasing polyethylene liner constraint on impingement-free ROM following rTSA. Additionally, these sequentially increasing constraint designs were evaluated with various humeral neck shaft angles (NSAs), glenosphere diameters, and a new variable termed the polyethylene rim width.

Methods: Twenty upper extremity cadavers were computed tomography scanned and manually segmented to developed three-dimensional models of the scapula and humerus. Each model was then virtually implanted with a generic rTSA implant. Nine different polyethylene constraint ratios (defined as the ratio between the polyethylene depth and polyethylene radius; with values ranging from 0.35-0.75 in 0.05 increments) were assessed, along with three NSAs (135°, 145°, and 155°), three glenosphere diameters (36mm, 39mm, and 42mm), and four polyethylene rim widths (1mm, 2mm, 3mm, and 4mm). This resulted in 108 different polyethylene designs and 324 different rTSA designs. All virtually implanted bone models were imported as rigid bodies into a custom motion software, in which six standard motions (abduction, adduction, forward elevation, extension, internal rotation, and external rotation) were conducted, followed by the assessment of global circumduction ROM. Impingement during each motion was automatically detected. The maximum impingement-free ROM for each implant configuration and motion pathway were then quantified and statistically assessed.

Results: Polyethylene constraint, polyethylene rim width, NSA, and glenosphere diameter were all found to significantly affect impingement-free ROM for all motions simulated (P<0.001). Increases in polyethylene constraint and rim width were found to significantly reduce impingement-free ROM (P<0.001). A 135° NSA with a 42mm glenosphere combination were found to maximize ROM during extension, adduction, internal rotation, external rotation, and global circumduction motion, while a 155° NSA with a 36mm glenosphere combination resulted in optimized abduction and forward elevation ROM.

Discussion: Increases in polyethylene constraint were found to significantly reduce impingement-free ROM for all motions evaluated. However, polyethylene constraint had the greatest impact on glenohumeral extension, adduction, internal rotation, external rotation, and global circumduction. Polyethylene rim width was also found to significantly affect impingement-free ROM for all motions. Further study is needed to determine the optimal value of polyethylene liner constraint in rTSA due to its impact on rTSA biomechanics, joint stability and ROM.

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来源期刊
CiteScore
6.50
自引率
23.30%
发文量
604
审稿时长
11.2 weeks
期刊介绍: The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
期刊最新文献
Editorial Board Table of Contents Sponsoring Societies Evaluation of New Normal After Shoulder Arthroplasty: Comparison of Anatomic versus Reverse Total Shoulder Arthroplasty. Excellent Clinical and Radiological Mid-term Outcomes of the Arthroscopic "Double-Inlay" Eden-Hybinette Procedure for Bone Defects Exceeding 20%: A 5-Year Case Series.
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