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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Comparison of Glenohumeral Contact Pressures and Contact Areas After Posterior Glenoid Reconstruction With Iliac Crest or Distal Tibia Osteochondral Allograft
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Comparison of Glenohumeral Contact Pressures and Contact Areas After Posterior Glenoid Reconstruction With Iliac Crest or Distal Tibia Osteochondral Allograft

机译：Glen骨或胫骨远端胫骨软骨同种异体移植后路类骨盂重建后的Glenohumeral接触压力和接触面积的比较

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Objectives: Posterior glenoid bone deficiency in the setting of posterior glenohumeral instability is typically addressed with bone block augmentation with iliac crest bone graft (ICBG). While this technique aims at decreasing posterior shoulder instability, the concern for the development of early, symptomatic, glenohumeral arthritis remains. Reconstruction with distal tibia allograft (DTA) is an alternative option, with the theoretical advantages of restoring the glenoid articular surface and improving joint congruity. The purpose of this study was to evaluate glenohumeral contact areas, contact pressures, and peak forces in (1) the intact glenoid and after (2) 20% posterior glenoid surface area defect from 6 o’clock to 10 o’clock (right shoulder), (3) 20% glenoid defect with flush posterior bone block graft with ICBG; and (4) 20% glenoid defect with DTA. The hypothesis was that reconstruction with DTA would more effectively restore normal glenoid contact pressures (CP), contact areas (CA), and peak forces (PF) when compared to the deficient glenoid. Methods: Eight fresh-frozen human cadaveric shoulders were randomly tested in four conditions as follows: (1) intact glenoid, (2) 20% posterior-inferior glenoid surface area defect, (3) 20% defect reconstructed with flush ICBG; and (4) 20% defect reconstructed with fresh DTA. For each condition, a 0.1mm-thick dynamic pressure-sensitive pad (sensor model 5051, Tekscan, Boston, MA) was pre-calibrated and placed between the humerus and glenoid. Each specimen was mounted onto a MTS testing machine (Insight 5, MTS systems, Eden Prairie, MN), which was used to apply a compressive load of 440-N for each condition in the following clinically relevant arm positions: (1) 30 degrees humeral abduction, (2) 60 degrees humeral abduction, and (3) 30 degrees humeral abduction-90 degrees flexion-45 degrees internal rotation (FIR). Glenohumeral CP (kg/cm2), CA (cm2), and joint PF (N) were recorded (Figure 1). All data was analyzed with a repeated measures one-way analysis of variance (ANOVA) with Tukey’s post- hoc test, when indicated. Results: Glenoid reconstruction with DTA resulted in significantly higher CA compared to the 20% defect model at 60 degrees (P<0.01) and at FIR (P<0.01). The intact state exhibited significantly higher CA than the defect in all positions (P<0.01), and significantly higher CA than ICBG at 60 degrees (P<0.05) and at FIR (P 0.05). Conclusion: Reconstruction of posterior glenoid bone defects with DTA demonstrated at least equivalent biomechanical properties compared to reconstruction with ICBG. Given the concern over the association of the extra-articular, non-anatomic ICBG reconstruction technique with the development of early, symptomatic, glenohumeral arthritis, this study suggests that posterior glenoid reconstruction with DTA is a viable alternative solution, with the potential advantage of improving joint congruity via an anatomic reconstruction resulting in a cartilaginous, congruent articulation with the humeral head. While these mechanical properties may translate into clinical differences, further studies are needed to understand their effects over time.
机译：目标：后盂肱肱关节不稳时的后盂盂骨缺损通常通过with骨植骨（ICBG）增强骨阻滞来解决。尽管该技术旨在减少后肩不稳定性，但仍需关注早期，有症状的盂肱关节炎的发展。胫骨远端同种异体移植（DTA）重建是一种替代选择，其理论优点是可以恢复关节盂关节面并改善关节全合。这项研究的目的是评估（1）完整的关节盂以及（2）从6点至10点（右肩）20％的后关节盂表面积不足后的盂肱接触面积，接触压力和峰值力），（3）20％关节盂缺损，ICBG齐平后路骨块移植; （4）含DTA的20％关节盂缺损。假设是与缺乏关节盂相比，DTA重建将更有效地恢复正常关节盂接触压力（CP），接触面积（CA）和峰值力（PF）。方法：在以下四个条件下随机测试八只新鲜冷冻的人尸体肩：（1）完整的盂盂;（2）后下盂盂表面积缺损20％;（3）用冲洗ICBG重建缺损20％; （4）用新鲜的DTA重建20％的缺陷。对于每种情况，都预先校准了厚度为0.1mm的动态压敏垫（传感器型号为5051，Tekscan，Boston，MA），并将其放置在肱骨和关节盂之间。将每个样本安装到MTS测试机（Insight 5，MTS系统，Eden Prairie，MN）上，该设备用于在以下临床相关的手臂位置上针对每种情况施加440-N的压缩载荷：（1）30度肱骨外展;（2）肱骨外展60度;（3）肱骨外展30度-屈曲90度-内旋（FIR）45度。记录了Glenohumeral CP（kg / cm2），CA（cm2）和关节PF（N）（图1）。如果有指示，则使用Tukey事后检验通过重复测量单向方差分析（ANOVA）对所有数据进行分析。结果：与60％的20％缺损模型（P <0.01）和FIR（P <0.01）相比，使用DTA重建Glenoid导致的CA明显更高。在60度（P <0.05）和FIR（P 0.05）时，完整状态的CA在所有位置均比缺陷高得多（P <0.01），并且比ICBG显着更高。结论：与ICBG重建相比，DTA重建后盂盂骨缺损至少具有相同的生物力学特性。鉴于对关节外非解剖性ICBG重建技术与早期有症状，盂肱型关节炎的发展相关性的担忧，这项研究表明，DTA后盂重建术是可行的替代解决方案，其潜在的优势是可以改善通过解剖重建实现关节全合，导致肱骨头与软骨的全合。尽管这些机械性能可能会转化为临床差异，但仍需要进一步研究以了解其随时间的作用。

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