Werthel Jean-David, Boux de Casson François, Burdin Valérie, Athwal George S, Favard Luc, Chaoui Jean, Walch Gilles
Hôpital Ambroise Paré, Boulogne-Billancourt, France.
Laboratory of Medical Information Processing, Brest, France.
Bone Jt Open. 2021 Jul;2(7):552-561. doi: 10.1302/2633-1462.27.BJO-2021-0081.R1.
The aim of this study was to describe a quantitative 3D CT method to measure rotator cuff muscle volume, atrophy, and balance in healthy controls and in three pathological shoulder cohorts.
In all, 102 CT scans were included in the analysis: 46 healthy, 21 cuff tear arthropathy (CTA), 18 irreparable rotator cuff tear (IRCT), and 17 primary osteoarthritis (OA). The four rotator cuff muscles were manually segmented and their volume, including intramuscular fat, was calculated. The normalized volume (NV) of each muscle was calculated by dividing muscle volume to the patient's scapular bone volume. Muscle volume and percentage of muscle atrophy were compared between muscles and between cohorts.
Rotator cuff muscle volume was significantly decreased in patients with OA, CTA, and IRCT compared to healthy patients (p < 0.0001). Atrophy was comparable for all muscles between CTA, IRCT, and OA patients, except for the supraspinatus, which was significantly more atrophied in CTA and IRCT (p = 0.002). In healthy shoulders, the anterior cuff represented 45% of the entire cuff, while the posterior cuff represented 40%. A similar partition between anterior and posterior cuff was also found in both CTA and IRCT patients. However, in OA patients, the relative volume of the anterior (42%) and posterior cuff (45%) were similar.
This study shows that rotator cuff muscle volume is significantly decreased in patients with OA, CTA, or IRCT compared to healthy patients, but that only minimal differences can be observed between the different pathological groups. This suggests that the influence of rotator cuff muscle volume and atrophy (including intramuscular fat) as an independent factor of outcome may be overestimated. Cite this article: 2021;2(7):552-561.
本研究旨在描述一种定量三维CT方法，用于测量健康对照者以及三个病理性肩关节队列中肩袖肌群的体积、萎缩情况和平衡性。
分析共纳入102例CT扫描：46例健康者，21例肩袖撕裂性关节病（CTA），18例不可修复性肩袖撕裂（IRCT），以及17例原发性骨关节炎（OA）。对四块肩袖肌进行手动分割，并计算其体积，包括肌内脂肪。通过将肌肉体积除以患者肩胛骨体积来计算每块肌肉的标准化体积（NV）。比较各肌肉之间以及各队列之间的肌肉体积和肌肉萎缩百分比。
与健康患者相比，OA、CTA和IRCT患者的肩袖肌体积显著减小（p < 0.0001）。CTA、IRCT和OA患者所有肌肉的萎缩情况相当，但冈上肌除外，其在CTA和IRCT中萎缩更显著（p = 0.002）。在健康肩部，前肩袖占整个肩袖的45%，而后肩袖占40%。在CTA和IRCT患者中也发现了类似的前后肩袖划分。然而，在OA患者中，前肩袖（42%）和后肩袖（45%）的相对体积相似。
本研究表明，与健康患者相比，OA、CTA或IRCT患者的肩袖肌体积显著减小，但不同病理组之间仅观察到极小差异。这表明，肩袖肌体积和萎缩（包括肌内脂肪）作为结局独立因素的影响可能被高估了。引用本文：2021;2(7):552 - 561。
