An Anatomical Study of the Trabecular Bone Density Distribution in the Scapula Adjacent to the Glenoid Fossa
Notice bibliographique
Résumé
Purpose Several orthopaedic surgical procedures performed on the shoulder joint require the fixation of implants by means of screw placement in the scapula. Secure anchoring in adequate bone‐quality is crucial for prosthetic stability. However, loss of implant fixation can occur due to screw loosening. This study examines the anatomic distribution of cancellous bone density in regions of the scapula adjacent to the glenoid available for screw placement. Method With approval of IRB, seven cadaveric shoulders were CT scanned at a slice thickness of 0.625mm and reconstructed in 3D using the commercially available image processing software (Mimics 15.0 Materialise, Leuven, Belgium). Volumetric regions of interest (ROI) for potential screw placement sites were identified: base of the coracoid process (lateral and inferior regions of the suprascapular notch), posterior and anterior aspect of the lateral spine and anterosuperior and posteroinferior aspect of the lateral border. Hounsfield Units (HU) values were extracted from voxels of the reconstructed 3D model corresponding to trabecular bone within each ROI. Overall bone density was summarized as the frequency of HU values above 80% of the ROI's maximum density value. Paired, two‐tailed t‐tests assuming unequal variance were used for pairwise comparisons (P≤0.05). Intra‐region analyses compared two ROIs within the same broad anatomical structure; inter‐region analyses compared ROIs between anatomical structures. Results Intra‐region comparisons were conducted and evaluated with the following results: base of coracoid P=0.43, spine P=0.95, lateral border P=0.41. Therefore, no significant differences were determined for intra‐regions comparisons. Inter region comparisons were also conducted and evaluated. Evaluation of the ROI inferior to the suprascapular notch determined this area was on average 3.78% (P=0.08) and 6% (P=0.04) less dense than the anterosuperior and posteroinferior lateral border and 7.59% (P=0.006) and 7.72% (P=0.01) less dense than the anterior and posterior lateral spine. This indicates that the cancellous bone inferior to the suprascapular notch is significantly less dense than that of the spine and lateral border. Evaluation of the ROI lateral to the suprascapular notch determined this area was on average 6% (P=0.05) and 8.21% (P=0.02) less dense than the anterosuperior and posteroinferior lateral border and 9.8% (P=0.006) and 9.94% (P=0.008) less dense than the anterior and posterior lateral spine. Therefore, the cancellous bone of the ROI lateral to the suprascapular notch is significantly less dense than that of the spine and lateral border. Finally, there was no significant difference between the anterior spine and anterosuperior and posteroinferior lateral border (P=0.12, P=0.58), nor between the posterior spine and anterosuperior and posteroinferior lateral border (P=0.14, P=0.57). This indicates the spine and lateral border do not have significantly different cancellous bone densities. Conclusion Results from this study indicate that the spine and lateral border of the scapula contain denser trabecular bone relative to the base of the coracoid process. Further research should be conducted in the areas studied to determine if screw purchase is increased in these areas of higher cancellous bone quality. Support or Funding Information Ryan T. Bicknell: Consulting for DePuy Orthopaedics and Zimmer Inc. Tim Bryant, Michael Rainbow, Ryan T. Bicknell: Research support from DePuy Orthopaedics.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».