[肩袖撕裂与肱骨头向上移位的相关性分析]
[Correlation analysis between rotator cuff tear and the superior migration of humeral head].
作者信息
Zhang Y C, Chen J H, Dang Y, Yang M, Fu Z G, Zhang D Y, Zhang P X, Jiang B G
机构信息
Department of Trauma and Orthopaedics, Peking University People's Hospital, Peking University Trauma Medicine Center, Beijing 100044, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Apr 18;51(2):273-276. doi: 10.19723/j.issn.1671-167X.2019.02.014.
OBJECTIVE
To evaluate the association between rotator cuff tear and the proximal migration of humeral head.
METHODS
In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.
RESULTS
In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).
CONCLUSION
UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.
目的
评估肩袖撕裂与肱骨头近端移位之间的关联。
方法
本研究中，我们回顾性选取了2015年9月至2016年5月在北京大学人民医院的30例单侧肩袖撕裂患者，这些患者在纳入本研究前均接受了患侧肩部的磁共振成像（MRI）和X线检查，两次检查间隔时间不超过1周，且所选肩部既往无手术史。无其他排除标准。上移指数（UMI）是肱骨头中心至肩峰下表面的距离与肱骨头圆周半径之比，与传统的肩峰肱骨头距离（AHD）相比，它有助于最大限度地减少解剖差异和成像放大的影响。然后我们引入该指数将所选的30例患者分为3组，每组10例，第1组的UMI>1且≤1.2，第2组的UMI>1.2且≤1.4，第3组的UMI>1.4。由于在四条肩袖肌腱中，冈上肌最常发生病理改变，我们将其作为研究对象。然后我们使用Spearman相关性分析来评估UMI与脂肪变性、肩袖撕裂大小以及X线和MRI所示冈上肌腱断裂厚度之间的关系。
结果
在前后位视图中，平均UMI为1.33（1.02 - 1.51，标准差：±0.22）。UMI与撕裂大小呈显著负相关（R = -0.584，P < 0.01），冈上肌脂肪变性之间也存在负相关（R = -0.312，P = 0.033）。然而，UMI与冈上肌腱断裂厚度之间无相关性（R = 0.127，P = 0.071）。
结论
UMI与冈上肌脂肪变性和撕裂大小有关。UMI降低是临床上肩袖撕裂和退变的一个可预测且可靠的标志。面对肩部疼痛患者时，医生可首先进行体格检查和X线检查，这对于评估肩袖撕裂方便且有帮助。
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