有症状和无症状肩袖撕裂的肩部肱骨头近端移位
Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears.
作者信息
Keener Jay D, Wei Anthony S, Kim H Mike, Steger-May Karen, Yamaguchi Ken
机构信息
Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
出版信息
J Bone Joint Surg Am. 2009 Jun;91(6):1405-13. doi: 10.2106/JBJS.H.00854.
BACKGROUND
Proximal humeral migration is commonly seen in rotator-cuff-deficient shoulders. The specific effects of the size of the rotator cuff tear and of pain on glenohumeral kinematics have been poorly defined. The purpose of this study was to examine the influences of cuff tear size and pain, separately, on humeral migration in a series of patients with symptomatic and asymptomatic rotator cuff tears.
METHODS
Ninety-eight asymptomatic and sixty-two symptomatic shoulders were identified from a cohort of patients with unilateral shoulder pain related to rotator cuff disease. All shoulders underwent ultrasonographic evaluation of the rotator cuff and standardized radiographic evaluation. Humeral migration was measured by three observers using software-enhanced radiographic analysis.
RESULTS
There was no significant difference in rotator cuff tear size between the asymptomatic and symptomatic shoulders, although more tears involved the infraspinatus in the symptomatic group (p = 0.01). Proximal humeral migration was greater in the shoulders with a symptomatic tear than it was in those with an asymptomatic tear (p = 0.03). Tears that involved the infraspinatus resulted in more migration than did isolated supraspinatus tears in both the symptomatic (p = 0.01) and the asymptomatic shoulders (p = 0.03). When the symptomatic tears of > or =175 mm(2) were analyzed separately, the size of the tear was found to correlate strongly with humeral migration (p = 0.01). However, when the symptomatic tears that were <175 mm(2) were analyzed, neither tear size nor pain was found to have a significant relationship with migration. When the analysis was limited to full-thickness symptomatic tears of > or =175 mm(2), both pain (p = 0.002) and tear area (p = 0.0002) were found to have a significant effect on migration. Multivariate analysis showed that tear size (p = 0.01) was the strongest predictor of migration in symptomatic shoulders.
CONCLUSIONS
Proximal humeral migration correlates with rotator cuff tear size. Tears extending into the infraspinatus tendon are associated with greater humeral migration than is seen with isolated supraspinatus tears. Humeral migration resulting from symptomatic rotator cuff tears is greater than that resulting from asymptomatic tears. Additionally, there is a critical size for tendon tears resulting in humeral migration in painful shoulders. Although both pain and tear size influence glenohumeral kinematics in symptomatic shoulders, only tear size is an independent predictor of humeral migration.
背景
肱骨近端移位在肩袖损伤的肩部很常见。肩袖撕裂大小和疼痛对盂肱关节运动学的具体影响尚未明确。本研究的目的是分别研究肩袖撕裂大小和疼痛对一系列有症状和无症状肩袖撕裂患者肱骨移位的影响。
方法
从一组与肩袖疾病相关的单侧肩部疼痛患者中确定了98例无症状肩部和62例有症状肩部。所有肩部均接受了肩袖的超声评估和标准化的影像学评估。由三名观察者使用软件增强的影像学分析测量肱骨移位。
结果
无症状和有症状肩部的肩袖撕裂大小无显著差异，尽管有症状组中更多的撕裂累及冈下肌（p = 0.01）。有症状撕裂的肩部肱骨近端移位大于无症状撕裂的肩部（p = 0.03）。在有症状肩部（p = 0.01）和无症状肩部（p = 0.03）中，累及冈下肌的撕裂比孤立的冈上肌撕裂导致更多的移位。当单独分析≥175 mm²的有症状撕裂时，发现撕裂大小与肱骨移位密切相关（p = 0.01）。然而，当分析<175 mm²的有症状撕裂时，未发现撕裂大小和疼痛与移位有显著关系。当分析仅限于≥175 mm²的全层有症状撕裂时，发现疼痛（p = 0.002）和撕裂面积（p = 0.0002）对移位均有显著影响。多变量分析表明，撕裂大小（p = 0.01）是有症状肩部移位的最强预测因素。
结论
肱骨近端移位与肩袖撕裂大小相关。延伸至冈下肌腱的撕裂比孤立的冈上肌撕裂导致更大的肱骨移位。有症状肩袖撕裂导致的肱骨移位大于无症状撕裂。此外，导致疼痛肩部肱骨移位的肌腱撕裂存在一个临界大小。虽然疼痛和撕裂大小均影响有症状肩部的盂肱关节运动学，但只有撕裂大小是肱骨移位的独立预测因素。
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