Effects of prosthesis design and placement on shoulder kinematics and strength after reverse shoulder arthroplasty

假体设计和放置对反向肩关节置换术后肩部运动学和力量的影响

• 批准号: 9808192
• 负责人: William J. Anderst
• 金额: $ 7.83万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9808192
• 关键词: Activities of Daily Living; Affect; Arthritis; Articular Range of Motion; Back; Cadaver; Clinical; Comorbidity; Complication; Computer Simulation; Data; Diagnostic radiologic examination; Dimensions; Environment; Future; Geometry; Goals; Hair; Head; Image; Implant; In Vitro; Inferior; Isotonic Exercise; Joint structure of shoulder region; Joints; Knowledge; Lead; Location; Measures; Mechanics; Modification; Motion; Movement; Muscle; Operative Surgical Procedures; Outcome; Outcome Study; Participant; Patient-Focused Outcomes; Patients; Procedures; Process; Prosthesis; Prosthesis Design; Protocols documentation; Quality of life; Rehabilitation therapy; Replacement Arthroplasty; Research; Rotation; Rotator Cuff; Shoulder; Skin; Sterile coverings; System; Techniques; Touch sensation; Translations; age effect; arm; bone; deltoid muscle; design; feeding; functional outcomes; implantation; improved; in vivo; kinematics; notch protein; novel; older patient; rotator cuff tear; scapula; secondary analysis

Project Summary/Abstract Reverse shoulder arthroplasty (RSA) is a surgical procedure most often performed on elderly patients with symptomatic shoulder arthritis who are unable to elevate their arm due to an irreparable rotator cuff tear. Prior to surgery, patients may have pseudoparalysis that severely limits their ability to independently perform common activities of daily living (ADLs). RSA restores strength and range of motion (ROM) by allowing the deltoid to compensate for an absent rotator cuff. Clinical outcomes after RSA are generally favorable, however, complication rates remain high and functional outcomes (e.g. range of motion and strength) remain suboptimal. Research on cadavers and computer simulations suggest that functional outcomes may be improved by modifying the design and placement of the shoulder prosthesis. However, controversy still exists as to the best implant geometry and implantation technique for maximizing shoulder function after RSA. This controversy persists, in large part, due to the paucity of quantitative in vivo motion data to guide this debate. Therefore, a critical need exists for quantitative in vivo shoulder motion in RSA patients. The long-term goal of our research is to improve clinical and functional outcomes for patients who receive RSA. The goals of this project are: 1) to identify the effects of prosthesis design and placement on shoulder motion and strength after RSA, and 2) to identify the motion and strength parameters that are associated with improved clinical outcomes. Participants will be 30 RSA patients who are 1 to 5 years post-surgery. We will use biplane radiography to image shoulder motion while participants perform scapular plane abduction, internal/external rotation at 90 abduction, touching the back of the head, and touching the middle of the lower back. A validated tracking system that has a precision of better than 1 mm in translation and 1 in rotation will determine shoulder joint motion during each movement. Shoulder strength will be measured using isokinetic dynamometry during flexion/extension, internal/external rotation, and ab/adduction. The Specific Aims are to determine the in vivo effect of prosthesis placement and design on shoulder kinematics and strength after RSA, and to identify the shoulder kinematics and strength parameters that are associated with improved clinical outcomes. As part of a secondary analysis, we will determine the size and location of the contact region between the glenosphere and humerosocket to characterize the mechanical environment of the prosthesis, and the distance between the humerosocket and scapula to identify in vivo motions that may lead to scapular notching. The expected outcome of this study will be novel data relating prosthesis placement and design to in vivo shoulder function and clinical outcomes after RSA. This knowledge can be used to improve clinical and functional outcomes, leading to improved quality of life for RSA patients. This study will provide preliminary data to inform future studies to investigate the effects of age, comorbidities, and rehabilitation on shoulder kinematics, strength and clinical outcomes after RSA.

项目摘要/摘要 反向肩关节置换术（RSA）是一种外科手术，通常是对古老的患者进行的 由于无法弥补的肩袖撕裂而无法抬高手臂的症状性肩部关节炎。事先的 进行手术，患者可能患有伪分析，严重限制了他们独立执行的能力 日常生活的常见活动（ADL）。 RSA通过允许恢复力量和运动范围（ROM） 三角肌以补偿缺失的肩袖。但是，RSA后的临床结果通常是有利的 并发症率保持较高，功能结果（例如，运动和强度范围）仍然是最佳选择。 关于尸体和计算机模拟的研究表明，功能结果可能通过 修改肩膀假体的设计和位置。但是，关于最好的争议仍然存在 植入物几何形状和植入技术，可在RSA后最大化肩部功能。这个争议 在很大程度上，由于体内运动数据的定量很少，因此持续存在。因此， 对于RSA患者的体内肩部运动，存在至关重要的需求。我们研究的长期目标 是为了改善接受RSA的患者的临床和功能结果。该项目的目标是：1） 确定假体设计和放置对RSA后肩部运动和强度的影响，以及2） 确定与改善临床结果相关的运动和强度参数。参与者 手术后1至5年的RSA患者将是30名RSA患者。我们将使用双翼片来形象肩 运动时，参与者进行肩cap骨绑架，内部/外部旋转90 触摸头部后部，并触摸下背部的中间。具有验证的跟踪系统 在翻译中的精度高于1毫米，旋转1毫米将确定每个过程中的肩部关节运动 移动。肩部强度将在屈曲/伸展过程中使用等式大量计测量 内部/外部旋转和AB/内收。具体目的是确定假体的体内效应 RSA后的肩部运动学和力量放置和设计，并识别肩膀运动学 与改善临床结果相关的强度参数。作为次级分析的一部分， 我们将确定Glenosphere和Haneosocket之间的接触区域的大小和位置 表征假体的机械环境，以及人脉和人物之间的距离 肩cap骨识别可能导致肩cap骨的体内运动。这项研究的预期结果将 成为新的数据，将假体放置和设计与体内的肩部功能和临床结果相关 RSA。这些知识可用于改善临床和功能结果，从而提高质量 RSA患者的寿命。这项研究将提供初步数据，以告知未来的研究以调查影响 RSA后的肩部运动学，力量和临床结果的年龄，合并症和康复。