肩袖完整性对反式肩关节置换术前后负荷和运动的影响
Influence of Rotator Cuff Integrity on Loading and Kinematics Before and After Reverse Shoulder Arthroplasty
摘要：
反向肩关节置换术（RSA）已成为肩关节置换术的一种非常常见的手术，即使是在传统上使用解剖重建的情况下。在这项研究中，我们调查关节反作用力和肩胛骨运动学的肩袖撕裂的不同肌腱和反向假体。将前屈期间的可用运动捕捉数据输入到有限元肌肉骨骼肩部模型，并使用逆动力学计算肌肉激活。该模型在体内盂肱关节反作用力（JRF）测量方面进行了验证，并与现有的临床和生物力学数据进行了比较。对完整的关节以及肩袖撕裂中涉及的各种肌腱进行了模拟：上（冈上肌）、上前（冈上肌和肩胛下肌）和上后（冈上肌、冈下肌和小圆肌）。在移位肱骨和盂肱关节旋转中心后，重复每个肩袖撕裂条件，以模拟反向假体的效果。分析了压缩、剪切和总JRF的变化，以及肩胛骨向上旋转。该模型相比，有利的体内测量，现有的临床和生物力学知识。模拟的JRF位于体内JRF测量值范围内，并显示超过90度屈曲后线性增加。植入功能性肩袖或孤立冈上肌撕裂的反向假体导致的压缩力分量比大面积肩袖撕裂（上前或上后）高2倍以上。这种较高的压缩力可能会增加磨损和植入物断裂的风险。
英文摘要：
Reverse Shoulder Arthroplasty (RSA) has become a very common procedure for shoulder joint replacement, even for scenarios where an anatomical reconstruction would traditionally be used. In this study, we investigate joint reaction forces and scapular kinematics for rotator cuff tears of different tendons with and without a reverse prosthesis. Available motion capture data during anterior flexion was input to a finite-element musculoskeletal shoulder model, and muscle activations were computed using inverse dynamics. The model was validated with respect to in-vivo glenohumeral joint reaction force (JRF) measurements, and also compared to existing clinical and biomechanical data. Simulations were carried out for the intact joint as well as for various tendons involved in a rotator cuff tear: superior (supraspinatus), superior-anterior (supraspinatus and subscapularis), and superior-posterior (supraspinatus, infraspinatus and teres minor). Each rotator cuff tear condition was repeated after shifting the humerus and the glenohumeral joint center of rotation to simulate the effect of a reverse prosthesis. Changes in compressive, shear, and total JRF were analysed, along with scapular upward rotation. The model compared favourably to in-vivo measurements, and existing clinical and biomechanical knowledge. Simulated JRF lie in the ranges of in-vivo JRF measurements and shows a linear increase past 90 degree flexion. Implanting a reverse prosthesis with a functional rotator cuff or with an isolated supraspinatus tear led to over 2 times higher compressive force component than with massive rotator cuff tears (superior-anterior or superior-posterior). Such higher compression forces might increase the risk of wear and implant fracture.
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