Hamada K, Fukuda H, Mikasa M, Kobayashi Y
Department of Orthopaedic Surgery, Tokai University Oiso Hospital, Japan.
Clin Orthop Relat Res. 1990 May(254):92-6.
It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based on these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.
术前很难确定肩袖撕裂的大小和位置。但采用特殊的关节造影技术，在65例经手术证实的肩袖撕裂病例中，约80%的诊断准确率是可能的。通过这种技术，在保守治疗的患者中发现了22例巨大肩袖撕裂。对这些患者，还分析了初次检查时获得的普通X线片。X线表现包括肩峰下间隙变窄以及肱骨头、结节、肩峰、肩锁关节和盂肱关节的退行性改变。基于这些数据，确定了巨大肩袖撕裂的五个X线分级。在七例经保守治疗并随访超过八年的巨大撕裂患者中，有五例X线分级进展。一例肩部发展为肩袖撕裂性关节病。基于这些观察结果，有人提出以下发病机制与X线改变的进展有关：（1）日常生活活动中手臂抬高，（2）肱二头肌长头肌腱断裂，（3）肱骨头相对于肩峰和喙肩韧带的异常支点，以及（4）外旋无力。巨大肩袖撕裂会发展为肩袖撕裂性关节病，其发展的每一步都伴有特征性的X线改变。
