Huang Chung-Cheng, Ko Sheung-Fat, Ko Jih-Yang, Wan Yung-Liang, Cheng Yu-Fan, Wang Ching-Jen
Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung, Taiwan, ROC.
J Formos Med Assoc. 2006 Feb;105(2):132-8. doi: 10.1016/S0929-6646(09)60334-X.
Bony deformity and muscular malfunction around the shoulder induced by deltoid contracture may influence rotator cuff function and lead to subsequent tearing. The purpose of this study was to investigate the imaging and clinical factors related to rotator cuff tear in patients with deltoid contracture.
We retrospectively reviewed 48 shoulders in 44 patients with magnetic resonance imaging diagnosis of deltoid contracture and surgically-proven rotator cuff tear. These shoulders were subdivided into partial-thickness and full-thickness tear groups. Another 17 shoulders in 17 patients with deltoid contracture but no evident rotator cuff tear were included as the control group. The characteristics, including age, gender and imaging features, of these three groups were compared.
Two patients who underwent initial operations for cuff tears required secondary operations for distal release of deltoid contracture. The age of patients with full-thickness tear was significantly greater than that of patients with partial-thickness tear or without tear. The winging angle of the glenoid (WAG) in the full-thickness tear group was significantly greater than that in the partial-thickness tear group. Patients with partial-thickness tear also had greater WAG than those without tear. However, WAG was not significantly correlated with the fibrotic size or age of the patient.
In patients with deltoid contracture, age and WAG are associated with the development of rotator cuff tear. To prevent the occurrence of rotator cuff tear, early surgical release of deltoid contracture is highly recommended, especially in patients with greater WAG.
三角肌挛缩引起的肩部骨畸形和肌肉功能障碍可能影响肩袖功能并导致随后的撕裂。本研究的目的是调查三角肌挛缩患者肩袖撕裂的影像学和临床相关因素。
我们回顾性分析了44例经磁共振成像诊断为三角肌挛缩且经手术证实存在肩袖撕裂的患者的48个肩部。这些肩部被分为部分厚度撕裂组和全层厚度撕裂组。另外17例患有三角肌挛缩但无明显肩袖撕裂的患者的17个肩部被纳入对照组。比较这三组的特征，包括年龄、性别和影像学特征。
两名因肩袖撕裂接受初次手术的患者需要二次手术以进行三角肌挛缩的远端松解。全层厚度撕裂患者的年龄显著大于部分厚度撕裂或无撕裂患者。全层厚度撕裂组的关节盂翼状角（WAG）显著大于部分厚度撕裂组。部分厚度撕裂患者的WAG也高于无撕裂患者。然而，WAG与患者的纤维化大小或年龄无显著相关性。
在三角肌挛缩患者中，年龄和WAG与肩袖撕裂的发生有关。为防止肩袖撕裂的发生，强烈建议早期手术松解三角肌挛缩，尤其是在WAG较大的患者中。
