Bell Simon N, Troupis John M, Miller David, Alta Tjarco D, Coghlan Jennifer A, Wijeratna Malin D
Melbourne Shoulder and Elbow Centre, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
Department of Diagnostic Imaging, Monash Health, Melbourne, VIC, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, VIC, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, VIC, Australia.
J Shoulder Elbow Surg. 2015 Apr;24(4):e83-90. doi: 10.1016/j.jse.2014.09.020. Epub 2014 Nov 7.
Because a 4-dimensional CT scan (4D CT) is able to provide a moving 3-dimensional (3D) image in real time in patients with snapping scapula syndrome, a 4D CT scan should be able to demonstrate bony impingement of the scapula on the posterior thorax. This study was performed to determine if 4D CT scans aid the clinician in defining the size and location of the scapular bone causing impingement in patients with snapping scapula syndrome.
Between October 2009 and August 2013, 12 patients (median age, 26.5 years; range 15-55 years) with snapping scapula syndrome were investigated with 4D CT. The images formed produced a dynamic volume-rendered reconstruction of the scapulothoracic joint that displayed its movements and any dynamic area of impingement of the scapula on surrounding bony structures. Asymmetry between symptomatic and asymptomatic scapulae was used to determine the radiologic cause of the patient's symptoms. After the failure of conservative management, 8 patients underwent surgery for their condition.
Five patients demonstrated bony contact of the scapula on the posterior thoracic ribs. Four patients demonstrated no bony contact but close apposition of the scapula to the posterior thoracic ribs. Three patients demonstrated no bony impingement but abnormal movement of the second and third rib caused by a soft-tissue tethering structure.
The 4D CT scan images defined pathology well in patients with snapping scapula syndrome and improved assessment of the amount and location of the scapular bone and soft tissue causing symptoms.
由于四维CT扫描（4D CT）能够为肩胛弹响综合征患者实时提供动态三维（3D）图像，因此4D CT扫描应该能够显示肩胛骨对后胸壁的骨质撞击。本研究旨在确定4D CT扫描是否有助于临床医生明确导致肩胛弹响综合征患者出现撞击的肩胛骨的大小和位置。
2009年10月至2013年8月期间，对12例肩胛弹响综合征患者（中位年龄26.5岁；范围15 - 55岁）进行了4D CT检查。所生成的图像对肩胛胸壁关节进行了动态容积再现重建，显示了其运动以及肩胛骨对周围骨质结构的任何动态撞击区域。通过有症状和无症状肩胛骨之间的不对称性来确定患者症状的放射学原因。在保守治疗失败后，8例患者接受了手术治疗。
5例患者显示肩胛骨与后胸壁肋骨存在骨质接触。4例患者未显示骨质接触，但肩胛骨与后胸壁肋骨紧密相邻。3例患者未显示骨质撞击，但因软组织束缚结构导致第二和第三肋骨运动异常。
4D CT扫描图像能很好地明确肩胛弹响综合征患者的病理情况，并改善了对引起症状的肩胛骨骨质和软组织的数量及位置的评估。
