Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, South Korea; Global Center for Shoulder & Elbow, Department of Orthopedic Surgery, Konkuk University Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, South Korea.
J Shoulder Elbow Surg. 2014 Jun;23(6):821-8. doi: 10.1016/j.jse.2013.08.016. Epub 2013 Nov 23.
Three-dimensional (3D) wing computed tomography (CT) showed a high inter-rater reliability in assessing scapular dyskinesis.
The 330 scapular movements of 165 patients were classified into 4 types by 7 blinded observers. Then, 3D wing CT was performed with patients prone, and 4 blinded observers measured 5 angles, consisting of upward rotation (UR) superior translation (ST), anterior tilting (AT), protraction (PRO), and internal rotation (IR). The inter-rater reliability (IRR) of 2 methods was calculated, and cutoff values were determined for the 5 angles on the 3D wing CT images.
The IRR was 0.783 for the observational method of scapular dyskinesis and 0.981 for 3D wing CT in the prone position. UR and ST angles were significantly larger in type 3 more than in the other types (P < .001, P < .001), and the AT angle showed a similar pattern in type 1 (P < .001). The PRO angle was significantly larger in types 1, 2, and 3 more than in type 4 (P < .001, P < .001, P = .013), and the IR angle was significantly larger in type 2 more than in the other types (P < .001). The cutoff values of the 5 angles were UR, 117°; ST, 90°; AT, 8°; PRO, 99°; and IR, 51°. The UR angle showed a significant correlation with glenohumeral internal rotation deficit (odds ratio, 0.436; P = .029) and the IR angle with MDI (odds ratio, 8.947; P = .048).
The patients with a high UR angle showed a low rate of glenohumeral internal rotation deficit and those with a high IR angle had a high rate of the MDI in affected shoulder by the determinant of the cutoff value of the 5 angles.
Level III, development of diagnostic criteria with nonconsecutive patients, diagnostic study.
三维（3D）肩胛骨 CT 成像在评估肩胛骨运动障碍方面具有较高的观察者间可靠性。
由 7 位盲法观察者对 165 例患者的 330 个肩胛骨运动进行分类。然后，让患者俯卧位进行 3D 肩胛骨 CT 检查，由 4 位盲法观察者测量 5 个角度，包括上旋（UR）、上移（ST）、前倾斜（AT）、前伸（PRO）和内旋（IR）。计算 2 种方法的观察者间可靠性（IRR），并确定 3D 肩胛骨 CT 图像上 5 个角度的截断值。
肩胛骨运动障碍的观察法的 IRR 为 0.783，俯卧位 3D 肩胛骨 CT 的 IRR 为 0.981。与其他类型相比，第 3 型的 UR 和 ST 角度明显更大（P <.001，P <.001），而第 1 型的 AT 角度也呈现出相似的模式（P <.001）。与第 4 型相比，第 1、2 和 3 型的 PRO 角度明显更大（P <.001，P <.001，P =.013），IR 角度在第 2 型中明显更大（P <.001）。5 个角度的截断值为 UR，117°；ST，90°；AT，8°；PRO，99°；IR，51°。UR 角度与盂肱关节内旋不足呈显著相关性（比值比，0.436；P =.029），IR 角度与 MDI 呈显著相关性（比值比，8.947；P =.048）。
UR 角度较高的患者，其盂肱关节内旋不足的发生率较低；IR 角度较高的患者，其患肩的 MDI 发生率较高，这是由 5 个角度的截断值决定的。
三级，基于非连续患者的诊断标准制定，诊断研究。
