| BackgroudThe antero-inferior instability of shoulder and the full or partial thickness tear of rotator cuff are very common in the clinic.Their etiology research will help us diagnose and treat them. In the last fifty years, most of studies in their etiology focused on bone geometry and soft tissue balance. But in the last two decades, more and more surgeons turn onto the soft tissue repair, such as rotator cuff repair with anchors, Bankart lesion repair, and so on. However, their failure rate was very high. This situation let us recognize whether their true pathogeny comes from the bone, soft tissue, or both of them. Is the normal shoulder different from the antero-inferior instability of shoulder and the full or partial thickness tear of rotator cuff in bone geometry?ObjectiveFirstly, we will set up a standard method to measure the bone geometry of glenohumeral joint with multi-slice CT technique. Then, by this method, we will study the relationship between the bony adaptability of the glenohumeral joint and the antero-inferior instability of shoulder, as well as rotator cuff tear.MethodsThere were 60 shoulders in 30 healthy adults, 24 shoulders with antero-inferior instability and 20 shoulders with rotator cuff tear. They were divided into 3 groups. In healthy group, there were 15 men and 15 women (right 30,left 30); In the antero-inferior instability group , there were 15 men and 9 women (right 17, left 7); In the rotator cuff tear group, there were 4 men and 16 women (right 14 , left 6). Their diognosis of all cases were proved by clinical exam, CT and MRI or surgery.Everyone was scanned with Siemens Somatom Sensation 16-slice scanner.The images were delivered to LEONARDO workstation and were analyzed with postprocessing technique of multiplanar reformation(MPR) and volume rendering technique(VRT).The parameters of humerus included the radius of curvature at coronal view and at axial view,inclination angle at coronal view. The parameters of glenoid included antero-posterior and supero-inferior radius of the curvature, inclination angle, retroversion angle in 4 planes from the superior to the inferior, the glenoid depth at coronal view and axial view, the antero-posterior and supero-inferior containment angle of curvature. The conformity index at coronal view and axial view, constraint index at coronal view and axial view were calculated. The means standard deviation,maximum value,minimum value of all parameters had been obtained by statistical analysis.The mean value of every parameter was compared each other.All parameters were processed statistically with soft ware SPSS10.0.Results1. There was significant difference in humeral inclination angle beteew the parameters measured with thin MPR and thick MPR by paired-samples t test. There was not significant difference in the other parameters measured with thin MPR and thick MPR by paired-samples t test.2. There was no significant difference (p>0.05) between the left and the right of healthy group by paired-samples t test in all parameters including the radius of humeral head curvature at coronal view and at axial view, humeral head inclination angle at coronal view, antero-posterior and supero-inferior radius of the glenoid curvature, glenoid inclination angle, glenoid retroversion angle in 4 planes from the superior to the inferior, the glenoid depth at coronal view and axial view, the antero-posterior and supero-inferior glenoid containment angle of curvature, the conformity index at coronal view and axial view, the constraint index at coronal view and axial view.3. In instability group,we got following results:(1)There was significant difference between the instability side and the normal side of the antero-inferior instability group in the antero-posterior radius of glenoid curvature(6.09±1.49 vs. 5.27±1.32cm,p=0.041), retroversion angle in the 4th plane(-2.5±6.44 vs. -5.5±2.48°, p=0.018),the antero-posterior containment angle of glenoid curvature(44.6±5.00 vs. 46.6±4.08°, p=0.023),the conformity index at axial view(0.35±0.079 vs. 0.40±0.092, p=0.023),the constraint index at axial view(0.12±0.015 vs. 0.13±0.010, p=0.023) (p<0.05) by paired-samples t test. There was no significant difference between the instability side and the normal side of the antero-inferior instability group in the other parameters. By independent-samples t test, there was significant difference beteew the parameters of the instability side and the parameters of healthy group in the antero-posterior(6.09±1.49 vs. 5.22±1.1cm, p=0.004) and the supero-inferior radius of glenoid curvature(4.99±0.85 vs. 4.58±0.76cm, p=0.019), the glenoid depth at axial view(2.21±0.20 vs. 2.5±0.48mm, p=0.000), the antero-posterior containment angle of glenoid curvature(44.6±5.00 vs. 47.0±4.08°, p=0.026), the conformity index at coronal view(0.45±0.074 vs. 0.48±0.083, p=0.038) and axial view(0.35±0.079 vs. 0.41±0.094, p=0.007).The others were no difference. There was correlations between 1st plane and 2nd plane(r=0.902 P<0.001), 2nd plane and 3rd plane(r=0.766 P<0.001), 3rd plane and 4th plane(r=0.875 P<0.001) of glenoid retroversion angle by correlation analysis in instability group .The mean value of the retroversion angle in 4th plane(-2.5°),the antero-posterior radius of glenoid curvature(6.09cm) of the instability side were the biggest.While the mean value of the conformity index at axial view(0.35),the constraint index at axial view(0.12) of instability side were the smallest.4. There was significant difference between the tear side and the normal side of the cuff tear group in the supero-inferior radius of glenoid curvature (4.62±0.48 vs. 4.95±0.56cm, p=0.006),the inclination angle of glenoid(104.8±4.45 vs. 101.7±4.95°, p=0.015), the conformity index at coronal view (0.46±0.042 vs. 0.43±0.060, p=0.038)by Paired-samples t test. There was significant difference beteew the tear side and the healthy group in glenoid inclination angle (104.8±4.45 vs. 100.7±5.32,°p=0.001) by independent-samples t test. The others were no difference. The mean value of the supero-inferior containment angle of glenoid curvature of the tear side(58.0°) was smallest.5. There was significant difference beteew the age of the cuff tear group and the healthy group(57.35±11.33 vs. 40.43±10.15 years, p=0.000) by independent-samples t test.Compared with the mean of the healthy group (40.43A) and the mean of the instability group(39.5A), the cuff tear group was eldest(57.35A).The patients suffered rotator cuff rear were elder.Conclusions1.The method of measuring bone geometry of the glenohumeral joint with postprocessing technique of MSCT is an useful technique for clinic measurement.2.There was significant difference in the antero-posterior radius of glenoid curvature, the retroversion angle in 4th planee, antero-posterior containment angle of glenoid curvature, conformity index at axial view, constraint index at axial view, glenoid depth at axial view ,which indicated, related with the risk of instability of the glenohumeral joint.3. There was significant difference in the supero-inferior radius of glenoid curvature, supero-inferior containment angle of glenoid curvature, conformity index at coronal view and inclination of glenoid, which implied, related with the risk of the rotator cuff tear. Based on this study,we concluded the bony adapbility of glenohumeral joint is related with the antero-inferior instability of shoulder, rotator cuff tear.
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