Glenoid morphology in light of anatomical and reverse total shoulder arthroplasty: a dissection- and 3D-CT-based study in male and female body donors

BMC Musculoskeletal Disorders

Research Article

Marco Burkhard¹  Oliver Ullrich¹  Ingeborg Franke¹  Helena Bischofberger¹  Elisabeth Eppler²  Sandra Mathews³  Nakita Frater³  Frank-Jakobus Rühli³  Nabil Serrano⁴  Karl Link⁴  Martin Häusler⁴  Thomas Böni⁵  Michael Thali⁶  Dominic Gascho⁶  Steffen Serowy⁷  Florian M. Buck⁸  Magdalena Müller-Gerbl⁹  Hans-Rudolf Bloch^1,10  Ford Qureshi^1,11  Gareth Harper^1,12 

[1] Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland;Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland;Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany;Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland;Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland;Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland;Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland;Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland;Technical Orthopedics Unit, University Hospital Balgrist, Zurich, Switzerland;Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland;Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany;Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland;Medical Faculty, University of Zurich, Zurich, Switzerland;Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland;Shoulder Surgery Unit, Ospedale Civico, Lugano, Switzerland;Shoulder Unit, Doncaster Royal Infirmary, Doncaster, UK;Shoulder Unit, Queen Alexandra Hospital, Portsmouth, UK;

关键词: Anatomical and reverse total shoulder arthroplasty;    Suprascapular nerve;    Screw placement;    Glenoid cavity;    Anteversion angle;    Retroversion angle;    Inclination angle;    Dissection study;   

DOI  :  10.1186/s12891-016-1373-4

 received in 2016-09-22, accepted in 2016-12-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPlacement of the glenoid baseplate is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty. However, the database around glenoid size is poor, particularly regarding small scapulae, for example, in women and smaller individuals, and is derived from different methodological approaches. In this multimodality cadaver study, we systematically examined the glenoid using morphological and 3D-CT measurements.MethodsMeasurements of the glenoid and drill hole tunnel length for superior baseplate screw placement were recorded to define size of the glenoid and the distance to the scapular notch on cadaveric specimens. Glenoid angles were determined on both, 3D-CT-scans of the thoraxes using the Friedman method and on subsequently isolated scapulae from 18 male and female donors (average 84 years, range 60–98 years).ResultsMean glenoid height was 36.6 mm ± 3.6, and width 27.8 mm ± 3.1 with a significant sex dimorphism (p ≤ 0.001): in males, glenoid height 39.5 mm ± 3.5, and width 30.3 mm ± 3.3, and in females, glenoid height 34.8 mm ± 2.2, and width 26.2 mm ± 1.6. The average distance from the superior screw entry to its exit in the scapular notch measured by calliper was 27.2 mm ± 6.0 with a sex difference: in males, 29.4 mm ± 5.7, and in females, 25.8 mm ± 5.9 mm with a minimum recorded distance of 15 mm. Measured by CT, the mean inclination angle for male and female donors combined was 13.0° ± 7.0, and the ante-/retroversion angle −1.0° ± 4.0°.ConclusionThis study is one of the first to combine dissection, including drill holes, with anatomical measurements and radiological data. In some women and smaller individuals, smaller baseplates should be selected. The published safe zone of 20 mm is generally feasible for superior screw placement, however, in small patients this distance may be substantially shorter than expected and start as of 13 and 15 mm, respectively. No correlation between glenoid height or width with the length of our drilling canal towards the scapular notch was found. Preoperative CT-based treatment planning to determine version and inclination angles is recommended.

【 授权许可】

CC BY   
© The Author(s). 2017