Musil D, Sadovský P, Rost M, Stehlík J, Filip L
Ortopedické oddělení Nemocnice České Budějovice, a. s.
Acta Chir Orthop Traumatol Cech. 2012;79(3):238-42.
To evaluate the effect of acromial morphology, as assessed on radiographs, on rotator cuff tears.
A total of 200 patients surgically treated for shoulder disorders were enrolled. All were older than 40 years and had good quality shoulder radiographs. Two groups were composed: First, a clinical model group of 136 patients to be investigated for three parameters of rotator cuff injury that was divided into two subgroups. One included 68 patients, with an average age of 53.5 years, in whom surgery revealed no injury to the rotator cuff; the other subgroup of 68 patients, with an average age of 58 years, had a ruptured supraspinatus tendon. Subsequently, a control group of 64 patients (32 with rotator cuff injury and 32 without it) was used to verify the results of the model group.
Three parameters describing the acromion, i.e., acromion index (AI), lateral acromion angle and acromial slope, were measured on standard radiographs. Tangential antero-posterior and scapular "Y" (supraspinatus outlet) views were taken, the images were digitalised and evaluated using a TomoCon 3.0 Viewer programme, and the results of the two groups were statistically analysed and compared.
The difference between the patients with rotator cuff injury and those without it was best shown, in both groups, by significant differences in the acromion index. This was true for both the men and women. The AI values for the patients with rotator cuff injury were 0.66 and 0.65 in the model and control groups, respectively. The same AI value of 0.76 was found for uninjured rotator cuffs in both groups. The two other parameters investigated did not appear to be of any significant validity for assessment of rotator cuff tears.
The aetiology of injury to the rotator cuff has not been fully understood yet but, undoubtedly, the causes will be many. The shape of the acromion is regarded as one of the important factors. We agree with Nyffeler et al. that a lateral extension of the acromion is most often associated with rotator cuff tears and that the acromion index proposed by these authors is a good parameter to assess this morphological change.
A lateral extension of the acromion plays an important role in the aetiology of degenerative tears of the supraspinatus tendon. The acromion index appears to be the best instrument for assessing this morphological change.
评估X线片上所显示的肩峰形态对肩袖撕裂的影响。
共纳入200例因肩部疾病接受手术治疗的患者。所有患者年龄均超过40岁，且肩部X线片质量良好。分为两组：第一组为临床模型组，共136例患者，针对肩袖损伤的三个参数进行研究，并分为两个亚组。一个亚组包括68例患者，平均年龄53.5岁，手术显示肩袖无损伤；另一个亚组68例患者，平均年龄58岁，冈上肌腱断裂。随后，设立一个64例患者的对照组（32例有肩袖损伤，32例无肩袖损伤）以验证模型组的结果。
在标准X线片上测量描述肩峰的三个参数，即肩峰指数（AI）、肩峰外侧角和肩峰坡度。拍摄前后位切线位和肩胛骨“Y”形（冈上肌出口位）片，将图像数字化并使用TomoCon 3.0 Viewer程序进行评估，对两组结果进行统计学分析和比较。
在两组中，肩袖损伤患者与未损伤患者之间的差异在肩峰指数上表现最为明显。男性和女性均如此。模型组和对照组中肩袖损伤患者的AI值分别为0.66和0.65。两组中未损伤肩袖的AI值均为0.76。所研究的其他两个参数对于评估肩袖撕裂似乎没有任何显著的有效性。
肩袖损伤的病因尚未完全明了，但毫无疑问，原因众多。肩峰的形状被视为重要因素之一。我们同意Nyffeler等人的观点，即肩峰的外侧延伸最常与肩袖撕裂相关，并且这些作者提出的肩峰指数是评估这种形态变化的一个良好参数。
肩峰的外侧延伸在冈上肌腱退行性撕裂的病因中起重要作用。肩峰指数似乎是评估这种形态变化的最佳工具。
