Feldman Viktor, Marom Niv, Nyska Meir, Kotz Eugene, Koh Jonathan E J, Barchilon Vidal
Orthopedic Department, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel.
Eur J Orthop Surg Traumatol. 2018 Feb;28(2):207-212. doi: 10.1007/s00590-017-2036-3. Epub 2017 Sep 20.
Understanding the real shape of the undersurface of the acromion prior to acromioplasty is indispensable. Today, Supraspinatus outlet view (SSOV) is a standard view used to determine the shape of the anterior acromion. Three types of acromial undersurface were described by Bigliani and Morrison. The purpose of this study was to find out whether the real acromial type can be visualized on X-ray SSOV and compare the shape of the anterior undersurface of the acromion visualized on SSOV, with the shape revealed on 2D CT reconstructions.
The SSOV X-rays and CT scans of 30 consecutive patients suffering from rotator cuff dysfunction were retrospectively analyzed. The shape of the acromion visualized on plain X-rays was classified according to Bigliani and Morrison classification system. Two-dimensional CT reconstructions were performed, reproducing the lateral, middle, and medial sections of the acromion. The acromial type that was visualized on each of those reconstructions was separately classified according to the Bigliani and Morrison system. A complete profile of the acromial undersurface was constructed from the integration of acromial types seen on each CT section. The acromial morphology seen on X-rays and CTs was compared.
A total of 30 patients comprised the study cohort; mean age was 57 (STD = 8.5) years. Three Type I, 22 Type II, and 5 Type III acromions were visualized on the SSOV X-rays. CT reconstructions revealed seven different morphological acromial profiles (I,I,I; I,II,II; I,II,III, etc.), which we divided into 3 groups: (1) Uniform (30%), (2) Internally curved (20%), and (3) Internally hooked (50%). The acromial type visualized on X-ray correlated with the acromial type on at least one CT section in all of the cases. In the case of uniform acromial profile, there is a full correlation between the acromial type visualized on X-rays and the type visualized on CT. In non-uniform profiles, there was an incomplete correlation between the types of the acromion visualized on SSOV and CT. SSOV X-rays correlated with or underestimated, but never overestimated, the acromial morphological type.
The curved or hooked portion of the acromial undersurface is not always visualized on the SSOV. On X-rays, the middle and lateral sections are seen more accurate than the medial section.
Surgeons should be aware that SSOV X-rays may underestimate the true type of the acromial undersurface.
在进行肩峰成形术前了解肩峰下表面的真实形态至关重要。如今，冈上肌出口位视图（SSOV）是用于确定肩峰前部形态的标准视图。Bigliani和Morrison描述了三种肩峰下表面类型。本研究的目的是确定在X线SSOV上能否观察到真实的肩峰类型，并比较在SSOV上观察到的肩峰前下表面形态与二维CT重建显示的形态。
回顾性分析30例连续的肩袖功能障碍患者的SSOV X线片和CT扫描图像。根据Bigliani和Morrison分类系统对普通X线片上观察到的肩峰形态进行分类。进行二维CT重建，再现肩峰的外侧、中间和内侧部分。根据Bigliani和Morrison系统分别对每个重建图像上观察到的肩峰类型进行分类。通过整合每个CT切片上观察到的肩峰类型，构建肩峰下表面的完整轮廓。比较X线片和CT上观察到的肩峰形态。
共有30例患者纳入研究队列；平均年龄为57（标准差=8.5）岁。在SSOV X线片上观察到3例I型、22例II型和5例III型肩峰。CT重建显示出七种不同形态的肩峰轮廓（I，I，I；I，II，II；I，II，III等），我们将其分为3组：（1）均匀型（30%），（2）内部弯曲型（20%），（3）内部钩型（50%）。在所有病例中，X线片上观察到的肩峰类型与至少一个CT切片上的肩峰类型相关。在均匀型肩峰轮廓的情况下，X线片上观察到的肩峰类型与CT上观察到的类型完全相关。在非均匀轮廓中，SSOV和CT上观察到的肩峰类型之间存在不完全相关性。SSOV X线片与肩峰形态类型相关或低估，但从未高估。
肩峰下表面的弯曲或钩状部分在SSOV上并不总是能观察到。在X线片上，外侧和中间部分比内侧部分看得更准确。
外科医生应意识到，SSOV X线片可能会低估肩峰下表面的真实类型。
