Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
J Shoulder Elbow Surg. 2013 Jul;22(7):901-7. doi: 10.1016/j.jse.2012.09.015. Epub 2013 Jan 10.
Although findings of conventional radiography seem nonspecific, it is still the first imaging modality used to evaluate patients with rotator cuff tears. The purpose of this study is to determine whether the true anteroposterior (AP) view of the glenohumeral (GH) joint (the thorax is rotated to the affected shoulder for 35°-45°) is more sensitive than the conventional shoulder AP view (the beam and cassette are perpendicular to the torso but oblique to the glenohumeral joint) in terms of detecting rotator cuff tears.
Intermixed GH AP and conventional AP views of 160 consecutive shoulders, which were repaired by arthroscopic surgery, were reviewed in a blinded fashion. The detection rate of 5 pathognomonic signs for rotator cuff tear were determined by use of both radiographs: greater tuberosity (GT) sclerosis, GT osteophyte, subacromial (SA) osteophyte, GT cyst, and humeral head osteophyte. An additional comparison according to the tear size was performed.
The detection of all radiographic findings was significantly greater on the GH AP view than on the conventional AP view (P < .001 for GT sclerosis, P = .003 for GT osteophyte, P = .013 for GT cyst, P < .001 for SA osteophyte, and P = .002 for humeral head osteophyte). In subgroup analysis by tear size, GT sclerosis was identified significantly more on the GH AP view for all tear sizes, GT osteophytes showed a higher detection rate, especially in medium-sized tears, and SA osteophytes showed a higher detection rate in medium and large to massive tears.
The GH view is more sensitive than the conventional AP view for detecting pathognomonic findings of rotator cuff tear. In particular, the superiority of the GH AP view in detecting abnormal radiographic findings seemed prominent in medium-sized tears.
虽然常规 X 线摄影的结果似乎没有特异性，但它仍然是评估肩袖撕裂患者的首选影像学方法。本研究旨在确定在检测肩袖撕裂方面，真正的盂肱（GH）关节前后位（AP）视图（胸部向患侧旋转 35°-45°）是否比常规肩 AP 视图（射线束和暗盒垂直于躯干但向盂肱关节倾斜）更敏感。
以盲法方式回顾性分析 160 例连续接受关节镜手术修复的 GH AP 和常规 AP 混合 X 线片。使用两种 X 线片确定 5 个肩袖撕裂的特征性征象的检出率：大结节（GT）硬化、GT 骨赘、肩峰下（SA）骨赘、GT 囊肿和肱骨头骨赘。还根据撕裂大小进行了额外比较。
在 GH AP 视图上，所有影像学发现的检出率均明显高于常规 AP 视图（GT 硬化，P <.001；GT 骨赘，P =.003；GT 囊肿，P =.013；SA 骨赘，P <.001；肱骨头骨赘，P =.002）。根据撕裂大小的亚组分析，对于所有撕裂大小，GT 硬化在 GH AP 视图上的检出率均明显更高，GT 骨赘的检出率更高，尤其是在中等大小的撕裂中，而 SA 骨赘在中大和巨大撕裂中具有更高的检出率。
GH 视图比常规 AP 视图更能敏感地检测肩袖撕裂的特征性发现。特别是，GH AP 视图在检测中等大小撕裂的异常影像学发现方面的优势更为明显。
