基于2D-CT测量亚洲人群肩胛盂解剖学特征对反式全肩关节假体设计的参考

doi:10.3877/cma.j.issn.2095-5790.2026.03.004

目的

通过对亚洲人群肩胛盂的解剖结构相关数据进行测量，比较其与欧美人群的差异，为适合亚洲人群的反式全肩关节假体设计优化提供参考及设计思路。

方法

回顾性分析2021年1月至2023年7月于南京中医药大学附属医院影像科接受肩关节2D-CT扫描的142例健康成人的单侧肩关节影像数据，其中男60例、女82例。通过三维重建及影像归档与通信系统测量肩胛盂高度、宽度、后倾角、上倾角及轴位、冠状位曲率半径，并利用SPSS软件（26.0版本）进行统计学分析后与近五年关于欧美人群肩胛骨肩胛盂解剖学数据测量的研究结果进行比较。

结果

男性肩胛盂宽度（29.13±2.23）mm和高度（36.66±2.81）mm均大于女性（25.02±2.14）mm和（32.73±2.57）mm，差异具有统计学意义（P<0.001）；男性肩胛盂后倾角为3.10 （1.90，5.23）°，女性肩胛盂后倾角为1.85 （0.62，4.10）°，差异具有统计学意义（P<0.001）；男性上倾角为11.50（7.58，13.00）°，女性上倾角为9.65（6.15，14.20）°，性别间差异无统计学意义（P>0.05）。男性和女性轴位曲率半径分别为32.35（26.53，38.30）mm和35.70（27.80，43.15）mm，性别间差异有统计学意义（P<0.05）；男性和女性冠状位平均曲率半径分别为28.95（26.90，31.68）mm和27.45（25.05，29.45）mm，性别间差异有统计学意义（P<0.05）。相关性分析显示肩胛盂尺寸与性别、身高、体重呈正相关（P<0.001）。

结论

与既往报道的欧美人群肩胛盂解剖结构数据相比，亚洲人群肩胛骨肩胛盂尺寸、曲率半径较小，曲面基座可能更有利于贴合亚洲人群肩胛盂相对较小且曲率半径偏小的关节面形态，从而在理论上有助于提高基座与骨面的匹配度并优化初始力学环境。对于肩胛盂尺寸较小或骨量条件受限的老年患者，该类设计可能具有一定的潜在适用价值，但其对接触面积、骨切除量及长期固定效果的具体影响仍需进一步研究加以验证。

关键词: 反式全肩关节置换术, 肩胛盂, 解剖测量, 假体设计, 亚洲人群, 曲面基座

Background

Reverse total shoulder arthroplasty (RTSA) , originally designed by Grammont and Baulot, improved shoulder pain and range of motion in patients with rotator cuff tear joint disease . In clinical applications, numerous studies have also demonstrated RTSA's effectiveness . With the rapid development of RTSA, its indications have gradually expanded to include various serious shoulder joint diseases such as acute complex proximal humeral fractures and old shoulder dislocations that cannot be reduced. Nowadays, RTSA has become the preferred treatment option for large, irreparable rotator cuff tears, as it can effectively alleviate shoulder joint pain and improve function. However, its relatively high incidence of postoperative complications remains a key focus for all clinicians. At present, the mainstream prostheses used in clinical practice are often designed and optimized based on the anatomical features of the scapula in European and American populations. However, these features differ across racial groups. A few studies have provided reference parameters for designing bases suitable for the Asian population and have indicated that the glenoid is smaller in Asians than in Europeans and Americans. Therefore, the use of traditional prostheses may lead to a mismatch between the prosthesis and the glenoid, which, in turn, causes scapular impingement and eventually results in loosening of the glenoid prosthesis. In addition, the contact area between the base and the bone surface is an important factor affecting the prosthesis's survival rate. Currently, many types of prostheses are available for clinical selection, and the contact area between the base and the glenoid varies among them. Accurate understanding of the fine anatomical characteristics of the glenoid in the Asian population is crucial for ensuring the correct selection and precise fixation of prostheses and for reducing the risk of surgical complications. 2D-CT scanning image measurement has been widely used in morphological research on shoulder joints, with good methodological consistency and population comparability. Compared with other measurement methods, it is more convenient to operate and is suitable for large-scale population studies in the future. Secondly, the two-dimensional cross-section can clearly display bony markers, facilitating standardized measurement and ensuring high stability and reliability. In addition, this study focuses on analyzing the bony geometric characteristics, and two-dimensional measurements are sufficient to meet the research requirements. Therefore, in this study, we retrospectively used 2D-CT images of the glenoid from 142 Asian populations for anatomical measurements and combined 3D-CT images to measure several anatomical indicators.

Objective

To provide references and design ideas for the optimization of reverse total shoulder (RTS) prosthesis design suitable for the Asian population by measuring the anatomical structural-related data of the glenoid in the Asian population and comparing the differences between them and the European and American populations.

Methods

A retrospective analysis was conducted on the unilateral shoulder joint imaging data of 142 healthy adults who underwent 2D-CT scans of the shoulder joint in the Department of Imaging of the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2021 to July 2023. Among them, 60 were male, and 82 were female. The height, width, posterior inclination Angle, upward inclination Angle, axial and coronal curvature radii of the glenoid were measured through three-dimensional reconstruction and image archiving and communication system (PACS) . Statistical analysis was conducted using SPSS (version 26.0) , and the results were compared with those of previous research on the anatomical measurements of the scapula and scapular glenoid in European and American populations over the past 5 years.

Results

The width (29.13±2.23) mm and height (36.66±2.81) mm of the glenoid in males were both greater than those in females (25.02±2.14 ) mm, (32.73±2.57) mm, with significant differences (P <0.001) ; The glenoid retroversion Angle in males was 3.10 (1.90, 5.23) °, and that in females was 1.85 (0.62, 4.10) °, with a significant difference (P <0.001) . The superior inclination Angle was 11.50 (7.58, 13.00) ° for males and 9.65 (6.15, 14.20) ° for females. There was no significant difference between the genders (P >0.05) . The axial curvature radii of males and females were 32.35 (26.53, 38.30) mm and 35.70 (27.80, 43.15) mm, respectively, and there was significant difference between the genders (P <0.05) . The average coronal curvature radii of males and females were 28.95 (26.90, 31.68) mm and 27.45 (25.05, 29.45) mm, respectively, and there was significant difference between the genders (P <0.05) . Correlation analysis showed that the size of the glenoid was positively correlated with gender, height, and weight (P <0.001) .

Conclusion

Compared with the previously reported anatomical data of the glenoid in European and American populations, the glenoid size and curvature radius of the Asian population are smaller. The curved base may be more conducive to fitting the articular surface morphology of the Asian population, with relatively small glenoid and a smaller curvature radius, thereby theoretically improving the matching between the base and the bone surface and optimizing the initial mechanical environment. For elderly patients with small glenoids or limited bone mass, this design may have potential application value. However, its specific impact on contact area, bone resection volume, and long-term fixation effect still needs further research to verify.

Key words: Reverse total shoulder arthroplasty, Glenoid cavity, Anatomical measurements, Prosthesis design, Asian population, Curved base

图1 在三维重建图像测量肩胛盂宽度和高度

图2 在二维重建图像测量轴位曲率半径

图3 在二维重建图像测量冠状位曲率半径

图4 在二维重建图像测量后倾角注：Line 1为肩胛盂前后缘连线；Line 2为肩胛骨轴线的垂线；Line 3为肩胛骨轴线

图5 在二维重建图像测量上倾角注：Line 1为冈上窝线；Line 2为肩胛盂上下缘连线；Line 3为冈上窝线的垂线

表1 所有患者基线数据

性别	例数	年龄（岁,±s）	身高（cm, Q1- Q3）	体重（kg ,Q1- Q3）
男	60	42.77±11.75	171.50（168.75, 178.00）	74.60（70.00, 81.50）
女	82	44.85±10.17	160.00（158.00, 165.00）	60.00（55.00, 65.00）
检验值		t =1.13	Z =-8.36	Z =-7.46
P值		0.260	<0.01	<0.01

表1 所有患者基线数据

性别	例数	年龄（岁,±s）	身高（cm, Q1- Q3）	体重（kg ,Q1- Q3）
男	60	42.77±11.75	171.50（168.75, 178.00）	74.60（70.00, 81.50）
女	82	44.85±10.17	160.00（158.00, 165.00）	60.00（55.00, 65.00）
检验值		t =1.13	Z =-8.36	Z =-7.46
P值		0.260	<0.01	<0.01

表2 各测量指标不同性别之间结果对比

性别	例数	肩胛盂高度（mm,±s）	肩胛盂宽度（mm,±s）	上倾角（º, Q1- Q3）	后倾角（º, Q1- Q3）	轴位曲率半径（mm, Q1- Q3）	冠状位曲率半径（mm, Q1- Q3）
男	60	36.66 ± 2.81	29.13 ± 2.23	11.50 （7.58, 13.00）	3.10 （1.90, 5.23）	32.35 （26.53, 38.30）	28.95 （26.90, 31.68）
女	82	32.73 ± 2.57	25.02 ± 2.14	9.65 （6.15, 14.20）	1.85 （0.62, 4.10）	35.70 （27.80, 43.15）	27.45 （25.05, 29.45）
检验值		t =-8.65	t =-11.11	Z =-0.50	Z =-2.59	Z =-2.12	Z =-2.89
P值		<0.01	<0.01	0.617	<0.01	0.034	0.004
ICC		0.913	0.936	0.918	0.923	0.919	0.929
95% CI		0.881~0.937	0.912~0.954	0.889~0.942	0.895~0.945	0.889~0.942	0.903~0.983

表2 各测量指标不同性别之间结果对比

性别	例数	肩胛盂高度（mm,±s）	肩胛盂宽度（mm,±s）	上倾角（º, Q1- Q3）	后倾角（º, Q1- Q3）	轴位曲率半径（mm, Q1- Q3）	冠状位曲率半径（mm, Q1- Q3）
男	60	36.66 ± 2.81	29.13 ± 2.23	11.50 （7.58, 13.00）	3.10 （1.90, 5.23）	32.35 （26.53, 38.30）	28.95 （26.90, 31.68）
女	82	32.73 ± 2.57	25.02 ± 2.14	9.65 （6.15, 14.20）	1.85 （0.62, 4.10）	35.70 （27.80, 43.15）	27.45 （25.05, 29.45）
检验值		t =-8.65	t =-11.11	Z =-0.50	Z =-2.59	Z =-2.12	Z =-2.89
P值		<0.01	<0.01	0.617	<0.01	0.034	0.004
ICC		0.913	0.936	0.918	0.923	0.919	0.929
95% CI		0.881~0.937	0.912~0.954	0.889~0.942	0.895~0.945	0.889~0.942	0.903~0.983

图6 基线数据与肩胛盂尺寸的相关性分析注：本图矩阵中的数值为相关性系数r值，正负代表关联方向，颜色深浅反映相关程度（颜色越深，相关程度越大）；图中标注的星号（*P<0.05，**P<0.001）表示统计显著性，未标注者则关联不显著；图中圆形越接近椭圆，则表示指标间相关性越强，正圆则表示无显著相关性。

[1]	Sanchez-Urgelles P，Kolakowski L，Levin JM，et al. Development，Evolution，and Outcomes of More Anatomical Reverse Shoulder Arthroplasty[J]. J Clin Med，2024，13（21）:6513.
[2]	Kozak T，Bauer S，Walch G，et al. An update on reverse total shoulder arthroplasty: current indications，new designs，same old problems[J]. EFORT Open Rev，2021，6（3）: 189–201.
[3]	Franceschi F，Giovannetti De Sanctis E，Gupta A，et al. Reverse shoulder arthroplasty: State-of-the-art[J]. J ISAKOS，2023，8（5）: 306–317.
[4]	Ardebol J，Menendez ME，Narbona P，et al. Reverse shoulder arthroplasty for massive rotator cuff tears without glenohumeral arthritis can improve clinical outcomes despite history of prior rotator cuff repair: A systematic review[J]. J ISAKOS，2024，9（3）: 394–400.
[5]	Kobayashi EF，Oak SR，Miller BS，et al. Treatment of Massive Rotator Cuff Tears with Reverse Shoulder Arthroplasty[J]. Clin Sports Med，2023，42（1）: 157–173.
[6]	Preuss FR，Day HK，Peebles AM，et al. Reverse Total Shoulder Arthroplasty for Treatment of Massive，Irreparable Rotator Cuff Tear[J]. Arthrosc Tech，2022，11（6）: e1133–e1139.
[7]	Goldenberg BT，Samuelsen BT，Spratt JD，et al. Complications and implant survivorship following primary reverse total shoulder arthroplasty in patients younger than 65 years: a systematic review[J]. J Shoulder Elbow Surg，2020，29（8）: 1703–1711.
[8]	Kolmodin J，Davidson IU，Jun BJ，et al. Scapular Notching After Reverse Total Shoulder Arthroplasty: Prediction Using Patient-Specific Osseous Anatomy，Implant Location，and Shoulder Motion[J]. J Bone Joint Surg Am，2018，100（13）: 1095–1103.
[9]	Jung HJ，Nam TS，Park D，et al. Three-Dimensional Morphometric Analysis of Penetrative Depth and Size of Nonarthritic and Degenerative Arthritic Glenoids: Implications for Glenoid Replacement in Shoulder Arthroplasty[J]. Clin Orthop Surg，2020，12（2）: 224–231.
[10]	Zhou J，Zhong B，Qu R，et al. Anatomic measurement of osseous parameters of the glenoid[J]. Sci Rep，2022，12（1）: 13424.
[11]	Suroto H，Licindo D，Wibowo PA，et al. Morphology of Humeral Head and Glenoid in Normal Shoulder of Indonesian Population[J]. Orthop Res Rev，2022，14: 459–469.
[12]	Slocum AMY，Siu YC，Ma CM，et al. The study of 2-dimensional computed tomography scans of the glenoid anatomy in relation to reverse shoulder arthroplasty in the Southern Chinese population[J]. JSES Int，2021，5（4）: 714–721.
[13]	Mourad W，Wiater JM，Wiater BP，et al. Baseplate Options for Reverse Total Shoulder Arthroplasty[J]. Curr Rev Musculoskelet Med，2020，13（6）: 769–775.
[14]	Puckett CD，Gwilt MS，Collon KW，et al. Baseplate coverage in reverse total shoulder arthroplasty: a systematic review[J]. JSES Rev Rep Tech，2025，5（3）: 460–468.
[15]	Collin P，Nabergoj M，Ode G，等. 肱骨假体155°角、增加偏心距的Grammont反肩假体置换术后功能性内旋与肩胛下肌愈合和肩胛骨前倾相关[J]. 临床骨科杂志，2025，28（5）: 654.
[16]	李建安，林枫松，卜国云，等. 反肩关节置换治疗肱骨近端骨折的并发症：假体周围骨吸收和无菌性假体松动[J]. 中国组织工程研究，2022，26（15）: 2432–2438.
[17]	Griswold BG，Barker EP，Steflik MJ，et al. The Radius of Curvature of the Inferior Distal Clavicle Is Similar to That of the Glenoid in Both the Axial and Coronal Planes and Similar to the Inferior Coracoid[J]. Arthrosc Sports Med Rehabil，2023，5（4）: 100777.
[18]	Kim JS，Kim SC，Park JH，et al. Short-term clinical and radiologic outcomes of reverse total shoulder arthroplasty with navigation system in the Asian population: a retrospective comparative study[J]. JSES Int，2025，9（2）: 422–430.
[19]	Cho CH，Kim DH，Kim YJ，et al. Complications after reverse total shoulder arthroplasty in the Korean population: a single center study of 299 cases[J]. J Shoulder Elbow Surg，2025，34（5）: e280–e286.
[20]	Hirakawa Y，Manaka T，Ito Y，et al. Comparison of short-term clinical outcomes and radiographic changes in Grammont reverse shoulder arthroplasty between the French and Japanese populations: A propensity score-matched analysis[J]. J Orthop Sci，2024，29（1）: 128–132.
[21]	Park I，Oh JH，Yoo JC，et al. Clinical and Radiological Comparison between Asian-Type and Conventional Reverse Shoulder Arthroplasty: A Multicenter Randomized Controlled Trial[J]. Clin Orthop Surg，2025，17（4）: 664–672.
[22]	James J，Huffman KR，Werner FW，et al. Does glenoid baseplate geometry affect its fixation in reverse shoulder arthroplasty?[J]. J Shoulder Elbow Surg，2012，21（7）: 917–924.
[23]	Bonnevialle N，Geais L，Müller JH，et al. Effect of RSA glenoid baseplate central fixation on micromotion and bone stress[J]. JSES Int，2020，4（4）: 979–986.
[24]	Diaz MA，Hutchinson AJ，Ricchetti ET，et al. How to avoid baseplate failure: the effect of compression and reverse shoulder arthroplasty baseplate design on implant stability[J]. J Shoulder Elbow Surg，2024，33（2）: 389–398.
[25]	Klein A，Nové-Josserand L，Collotte P，et al. Incidence and risk factors for aseptic glenoid baseplate loosening in primary reverse shoulder arthroplasty using the Aramis implant baseplate with a minimum of 2 years follow-up[J]. J Shoulder Elbow Surg，2026，35（4）: 978–988.
[26]	Wang L，Yu W，Yin X，et al. Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study[J]. JAMA Netw Open，2021，4（8）: e2121106.
[27]	Creighton RA，Burrus MT，Werner BC，et al. Short-term clinical and radiographic outcomes of a hybrid all-polyethylene glenoid based on preoperative glenoid morphology[J]. J Shoulder Elbow Surg，2022，31（12）: 2554–2561.
[28]	Meier MP，Brandt LE，Saul D，et al. Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients[J]. Diagnostics （Basel），2022，12（10）: 2507.
[29]	Elshahhat A，Basyoni Y，Nour K. Comprehensive analysis of bony scapula morphology and anthropometry in a homogeneous population[J]. BMC Med Imaging，2025，25（1）: 262.
[30]	Modelhart M，Herbst EC，Kunde AMH，et al. While the bony glenoid is superiorly inclined，the glenoid surface is not[J]. JSES Int，2026，10（1）: 101377.

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Reference for the design of reverse total shoulder joint prostheses based on 2D-CT measurement of scapular glenoid anatomical characteristics in Asian populations

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Reference for the design of reverse total shoulder joint prostheses based on 2D-CT measurement of scapular glenoid anatomical characteristics in Asian populations