• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.186-191
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• 2018

Background: To determine the normal range of humeral head positioning on magnetic resonance imaging (MRI). Methods: We selected normal subjects (64 patients; group A) to study the normal range of humeral head positioning on the glenoid by MRI measurements. To compare the MRI measurement method with the computed tomography (CT), we selected group B (70 patients) who underwent both MRI and CT. We measured the humeral-scapular alignment (HSA) and the humeral-glenoid alignment (HGA). Results: The HSA in the control group was $1.47{\pm}1.05mm$, and the HGA with and without reconstruction were $1.15{\pm}0.65mm$ and $1.03{\pm}0.59mm$, respectively, on MRI. In the test group, HSA was $2.67{\pm}1.47mm$ and HGA with and without reconstruction was $1.58{\pm}1.16mm$ and $1.49{\pm}1.08mm$, on MRI. On CT, the HSA was $1.72{\pm}1.01mm$, and HGA with and without reconstruction were $1.54{\pm}0.96mm$ and $1.59{\pm}0.93mm$, respectively. HSA was significantly different according to image modality (p=0.0006), but HGA was not significantly different regardless of reconstruction (p=0.8836 and 0.9234). Conclusions: Although additional CT scans can be taken to measure decentering in patients with rotator cuff tears, reliable measurements can be obtained with MRI alone. When using MRI, it is better to use HGA, which is a more reliable measurement value based on the comparison with CT measurement (study design: Study of Diagnostic Test; Level of evidence II).

• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.16-23
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• 2019

Background: We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. Methods: 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. Results: The superoinferior and anteroposterior offset in the glenoid component were $0.42{\pm}0.07$, $0.50{\pm}0.08$ in the conventional group and $0.45{\pm}0.03$, $0.46{\pm}0.02$ in the PSG group. The inclination and version angles were $-1.93^{\circ}{\pm}4.31^{\circ}$, $2.27^{\circ}{\pm}5.91^{\circ}$ and $0.46^{\circ}{\pm}0.02^{\circ}$, $3.38^{\circ}{\pm}2.79^{\circ}$. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were $0.45{\pm}0.12$, $0.48{\pm}0.15$ in the conventional group and $0.46{\pm}0.59$ (p=0.794), $0.46{\pm}0.06$ (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. Conclusions: The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.