Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland.
Division of Medical Imaging, Hôpital Neuchâtelois, Neuchâtel, Switzerland.
J Shoulder Elbow Surg. 2018 Aug;27(8):1415-1421. doi: 10.1016/j.jse.2018.02.051. Epub 2018 Apr 24.
The implication of scapular morphology in rotator cuff tears has been extensively studied. However, the role of the greater tuberosity (GT) should be of equal importance. The aim of this study was to propose a new radiographic marker, the GT angle (GTA), which measures the position of the GT in relation to the center of rotation of the humeral head. The hypothesis was that a higher angle value would be associated with a higher likelihood in detecting a rotator cuff tear.
During 1 year, patients were prospectively recruited from a single institution specialized shoulder clinic in 2 different groups. The patient group consisted of individuals with a degenerative rotator cuff tear involving at least the supraspinatus. The control group consisted of individuals with no rotator cuff pathology. Individuals in both groups with congenital, post-traumatic, or degenerative alterations of the proximal humerus were excluded. The GTA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation by 3 observers at 2 different times.
The study recruited 71 patients (33 patients, 38 controls). Mean GTA value was 72.5° (range, 67.6°-79.2°) in patients and 65.2° (range, 55.8°-70.5°) for controls (P <.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P <.001). Interobserver and intraobserver reliability were high.
GT morphology is implicated in rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions.
肩胛骨形态与肩袖撕裂的关系已得到广泛研究。然而，大结节（GT）的作用也同样重要。本研究旨在提出一种新的影像学标志物，即 GT 角（GTA），用于测量 GT 在肱骨头旋转中心的位置。假设是，角度值越高，检测肩袖撕裂的可能性就越大。
在 1 年的时间里，我们从一家专门的肩部诊所前瞻性地招募了两组患者。患者组包括患有退行性肩袖撕裂的个体，至少涉及冈上肌。对照组由没有肩袖病理的个体组成。两组中患有先天性、创伤后或肱骨头近端退行性改变的个体均被排除。在中立位旋转手臂的前后位肩部 X 线图像上，由 3 名观察者在 2 个不同时间测量 GTA。
本研究共招募了 71 名患者（33 名患者，38 名对照组）。患者的 GTA 值平均值为 72.5°（范围，67.6°-79.2°），对照组为 65.2°（范围，55.8°-70.5°）（P<.001）。GTA 值大于 70°时，检测肩袖撕裂的可能性增加 93 倍（P<.001）。观察者间和观察者内的可靠性均较高。
GT 形态与肩袖撕裂有关。GTA 是一种可靠的影像学标志物，大于 70°时高度提示存在此类病变。
