Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2648-2655. doi: 10.1007/s00167-021-06602-y. Epub 2021 May 19.
The critical shoulder angle (CSA) and the acromion index (AI) are measurements of acromial shape reported as predictors of degenerative rotator cuff tears (RCT) and glenohumeral osteoarthritis (GH OA). Whether they are the cause or effect of shoulder pathologies is uncertain since pre-morbid radiographs most often are lacking. The main aim of this study was to investigate if CSA or AI were related to the development of RCT or GH OA after 20 years. A secondary aim was to investigate if the CSA and AI had changed over time.
In the hospital archive, 273 preoperative plain shoulder radiographs were found of patients scheduled for elective surgery other than cuff repair and arthroplasty. Forty-five images fulfilled the strict criteria published by Suter and Henninger (2015) and were used to measure CSA and AI with two independent assessors. No patient had any sign of OA in the index radiographs or any information in the medical records indicating RCT. After a median of 20 (16-22) years, 30 of these patients were radiologically re-examined with bilateral true frontal views and ultrasound of the rotator cuff. There were 19 men (20 study shoulders) and 11 females (12 study shoulders).
Mean age at follow-up was 56 (32-78) years. There was no correlation between CSA (r = 0.02) (n.s) or AI (r = - 0.13) (n.s) in the primary radiographs and OA at follow-up. Nor was any correlation found between index CSA (r = 0.12) (n.s) or AI (r = - 0.13) (n.s) and RCT at follow-up. Mean difference in CSA was - 1.7 (- 10-3) degrees and mean AI difference was - 0.04 (- 0.13-0.09) between the first and the second radiographs, 20 years later. Bilaterally, mean CSA was 32 and AI 0.61 at follow-up.
In this study, no correlation between the CSA, AI and development of OA or RCT could be found. The mean CSA and AI decreased over a 20-year period but the difference was very small. No difference was found between the study shoulders and the contralaterals. These findings question previously reported etiological associations between scapular anatomy and the development of OA or RCT and thereby the use of these calculations as the basis of treatment.
III.
临界肩角（CSA）和肩峰指数（AI）是报告的肩峰形态测量值，可作为退行性肩袖撕裂（RCT）和肩肱关节炎（GH OA）的预测指标。由于术前影像学检查通常缺乏，因此尚不确定它们是导致肩部病变的原因还是结果。本研究的主要目的是调查 CSA 或 AI 是否与 20 年后 RCT 或 GH OA 的发展有关。次要目的是调查 CSA 和 AI 是否随时间发生变化。
在医院档案中，发现了 273 例计划接受择期手术（非肩袖修复和关节置换术）的患者的术前普通肩部 X 线片。45 张图像符合 Suter 和 Henninger（2015 年）发表的严格标准，并由两名独立评估者测量 CSA 和 AI。指数 X 线片中没有任何 OA 迹象，也没有任何医疗记录信息表明存在 RCT。中位随访时间为 20 年（16-22 年）后，对其中 30 例患者进行双侧真正额状面和肩袖超声检查。共有 19 名男性（20 个研究肩）和 11 名女性（12 个研究肩）。
随访时平均年龄为 56 岁（32-78 岁）。初次 X 线片中 CSA（r=0.02）（无统计学意义）或 AI（r=-0.13）（无统计学意义）与随访时的 OA 之间无相关性。指数 CSA（r=0.12）（无统计学意义）或 AI（r=-0.13）（无统计学意义）与随访时的 RCT 之间也未发现相关性。20 年后，第一次和第二次 X 线片之间 CSA 的平均差值为-1.7（-10-3）度，AI 的平均差值为-0.04（-0.13-0.09）。双侧 CSA 的平均值为 32，AI 为 0.61。
在本研究中，CSA、AI 与 OA 或 RCT 的发展之间无相关性。CSA 和 AI 的平均值在 20 年内下降，但差异很小。研究肩与对侧肩之间无差异。这些发现质疑了先前报道的肩胛骨解剖结构与 OA 或 RCT 发展之间的病因学关联，因此这些计算不能作为治疗的基础。
III。
