Humeral baş lateralizasyonundan önce ve sonra anterior deltoid yapışma yerinin çeşitli kemik belirli noktalara(landmarklara) mesafesi

Year 2019, , 17 - 20, 25.04.2019

Ramadan Özmanevra , Erol Kaya

https://doi.org/10.30565/medalanya.479819

Cited By: 1

Abstract

Amaç: Deltoid kasın anterior kısmının moment kolu, ters omuz artroplastisinin çalışma prensibinde artar ve proksimal humerus cerrahisi sırasında deltoid kas yapışma yerinin anterior kısmı hasar görebilir. Bu çalışmanın amacı 5 mm kalınlığında glenoid implant yerleştirilmesi öncesi ve sonrası çeşitli kemik landmarklardan deltoid anterior, superior, medial yapışma noktalarına kadar olan mesafeleri bildirmektir. 

Hastalar ve Yöntemler: Bu çalışmada formalle fikse edilmiş erişkin 12 adet kadavra omuzu kullanıldı. 5 mm kalınlığındaki pegli glenoid deneme implant yerleştirilmeden önce ve yerleştirildikten sonra, tüberkulum majus tan deltoid insersiyosuna, akromiy-onun anterior-lateral köşesinden deltoid insersiyosuna, korakoid ucundan deltoid inser-siyosuna, glenoid üst polden deltoid insersiyosuna olan mesafeler ve humerus uzu-nluğu(tüberkulum majus tan lateral epikondile) dijital kumpas ve mezura kullanılarak ölçüldü. 

Bulgular: Mezura ile ölçümde, glenoidden deltoid yapışma yerine olan me-safe sağ omuzlarda implant sonrası grupta daha yüksekti (p=0.04). Tüm omuzlar kıyaslandığında, korakoidden deltodin yapışma yerine olan mesafe implant uygulan-mış grupta daha yüksekti (p=0,04). 

Sonuç: Deltoid yapışma yeri lateralizasyonu, glenoid etrafındaki kemik landmarklardan özellikle de korakoid ucundan tespit edilebilir. 

Keywords

deltoid, insersiyo, korakoid, akromiyon, tüberkulum majus

Anterior deltoid insertion distance to various bony landmarks before and after humeral head lateralization

Abstract

Aim: Moment arm of anterior part of deltoid muscle is increased as working principle of reverse shoulder arthroplasty and anterior part of deltoid muscle insertion could be damaged during proximal humerus surgery. The purpose of the present study was to report distances from various bony landmarks to anterior, superior, medial insertion points of deltoid before and after implantation 5mm thick glenoid implant. 

Patients and Methods: 12 shoulders of formalin fixed adult cadavers were used at the present study. The distances from greater tubercle to deltoid insertion, anterior-lateral corner of acromion to deltoid insertion, coracoid tip to deltoid insertion, upper pole of glenoid to deltoid insertion, and humeral length (greater tubercle to lateral epicondyle) were measured using digital caliper and measurement tape before and after implantation of 5mm thick pegged glenoid trial (Bigliani/Flatow Total shoulder arthroplasty, Zimmer, Warsaw, IN). 

Results: At tape measurement, glenoid to deltoid insertion distance was higher at post implant group at right shoulders (p:0.04). When all shoulders were compared, coracoid to deltoid insertion distance was higher at implanted group (p:0.04). 

Conclusion: Deltoid insertion lateralization could be detected from the bony landmarks around the glenoid especially the coracoid tip. 

Keywords

deltoid, insertion, coracoid, acromion, great tubercle

References

• 1. Schwartz DG, Kang SH, Lynch TS, Edwards S, Nuber G, Zhang LQ et al. The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study. J Shoulder Elbow Surg 2013;3:357-364. PMID:22608931
• 2. Klepps S, Auerbach J, Calhon O, Lin J, Cleeman E, Flatow E. A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus. J Shoulder Elbow Surg 2004;3:322-327. PMID:15111903
• 3. Gill DRJ, Cofield RH, Rowland C. The anteromedial approach for shoulder arthroplasty: the importance of the anterior deltoid. J Shoulder Elbow Surg 2004;13:532-537. PMID:15383810
• 4. Whatley AN, Fowler RL,Warner JJ, Higgins LD. Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair. J Shoulder Elbow Surg 2011;20:114-122. PMID:20800511
• 5. Rispoli DM, Athwal GS, Sperling JW, Cofield RH. The anatomy of the deltoid insertion.J Shoulder Elbow Surg 2009;3:386-90. PMID:19186076
• 6. Sakoma Y, Sano H, Shinozaki N, Itoigawa Y, Yamamoto N, Ozaki T et al. Anatomical and functional segments of the deltoid muscle. J Anat 2011;2:185-190. PMID:21118198
• 7. Jobin CM, Brown GD, Bahu MJ, Gardner TR, Bigliani LU, Levine WN et al. Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization. J Shoulder Elbow Surg 2012;10:1269-1277. PMID:22056324
• 8. Bergmann JH, de Leeuw M, Janssen TW, Veeger DH, Willems WJ. Contribution of the reverse endoprosthesis to glenohumeral kinematics. Clin Orthop Relat Res. 2008 Mar;466(3):594-8. PMID:18264847
• 9. Kontaxis A, Johnson GR. The biomechanics of reverse anatomy shoulder replacement--a modelling study. Clin Biomech (Bristol, Avon). 2009 Mar;24(3):254-60. PMID:19263572
• 10. Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg 2008;90A:1244–1251. PMID:18519317
• 11. Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg 2006; 88A (suppl 1, pt 2):178–190. PMID:16951091