Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Arthroscopy. 2019 Sep;35(9):2553-2561. doi: 10.1016/j.arthro.2019.03.050. Epub 2019 Aug 14.
To explore whether the critical shoulder angle (CSA) and acromion index (AI) on nonstandard anteroposterior (AP) radiographs could be used as parameters for rotator cuff tear (RCT) diagnosis and to determine the optimized parameters.
This study included 174 patients with RCTs or intact rotator cuffs in whom AP radiographs were obtained at our hospital. The radiographs were assessed by 2 independent radiologists and were grouped according to the Suter-Henninger criteria. The CSA and AI were measured on all films. We performed receiver operating characteristic curve analysis by calculating the area under the curve (AUC) to compare the sensitivity and accuracy of both parameters.
Of the 174 enrolled patients, only 47 (27%) met the requirements for standard AP films (types A1 and C1). On standard AP films, both the CSA and AI were significantly different between the RCT and control groups (P < .001 for CSA and P < .001 for AI), with AUCs of 0.86 and 0.80 for the CSA and AI, respectively. On nonstandard AP films (other radiograph types), the mean CSA value was not significantly different between the RCT and control groups (P = .536) whereas the AI showed a significant difference (P = .024). The AUCs were 0.57 for the CSA and 0.64 for the AI.
On standard AP films, both the CSA and AI could predict rotator cuff disorders, and the CSA had a higher diagnostic accuracy than the AI. In contrast, on nonstandard AP films, the diagnostic efficacy of the AI was better than that of the CSA. On the basis of this study, we suggest an evaluation of the AP films of patients before diagnosis to confirm whether the AP films meet the criteria for standard AP films.
Level I, diagnostic study.
探讨非标准前后位（AP）X 线片上的临界肩角（CSA）和肩峰指数（AI）能否作为肩袖撕裂（RCT）诊断的参数，并确定优化参数。
本研究纳入了在我院接受 AP 摄片的 174 例 RCT 或完整肩袖患者。由 2 位独立的放射科医生对 X 线片进行评估，并根据 Suter-Henninger 标准进行分组。对所有的 X 线片进行 CSA 和 AI 的测量。通过计算曲线下面积（AUC）来进行受试者工作特征曲线分析，以比较这两个参数的敏感性和准确性。
在纳入的 174 例患者中，仅有 47 例（27%）符合标准 AP 片（A1 型和 C1 型）的要求。在标准 AP 片上，RCT 组和对照组的 CSA 和 AI 均有显著差异（CSA：P <.001；AI：P <.001），CSA 和 AI 的 AUC 分别为 0.86 和 0.80。在非标准 AP 片（其他类型的 X 线片）上，RCT 组和对照组的 CSA 均值无显著差异（P =.536），而 AI 有显著差异（P =.024）。CSA 的 AUC 为 0.57，AI 的 AUC 为 0.64。
在标准 AP 片上，CSA 和 AI 均能预测肩袖疾病，且 CSA 的诊断准确性高于 AI。相反，在非标准 AP 片上，AI 的诊断效能优于 CSA。基于本研究，我们建议在诊断前评估患者的 AP 片，以确认 AP 片是否符合标准 AP 片的标准。
Ⅰ级，诊断研究。
