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是喙突下撞击还是肩峰下撞击导致肩胛下肌腱撕裂?对患者手术肩和健侧肩的 MRI 表现进行比较。

Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients.

机构信息

Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, İstanbul, Turkey.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey.

出版信息

Turk J Med Sci. 2023 Feb;53(1):273-281. doi: 10.55730/1300-0144.5582. Epub 2023 Feb 22.


DOI:10.55730/1300-0144.5582
PMID:36945924
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10387881/
Abstract

BACKGROUND: : The purpose of this study is to investigate whether the etiological factors accepted as causes of idiopathic subscapularis tears are true or not when the comparison is made with the opposite side healthy shoulder of the patients who underwent arthroscopic repair for an isolated subscapularis tear. METHODS: Sixteen patients who underwent shoulder arthroscopy between February 2016 and January 2018 and were diagnosed with isolated subscapularis tear were evaluated. The coracohumeral distance (CHDax), coracoid overlap (CO), and tuberculum minus cysts (TMC) were evaluated on the axial images of the MRI studies while the acromiohumeral distance (AHDsag), CHDsag, and subscapularis tendon slip number (STSN) on the sagittal oblique images and the AHDcor and SLAP lesion on the coronal oblique images. Degeneration of the coracoacromial ligament was evaluated during arthroscopy. RESULTS: The mean CHDsag (11.26-10.08), CHDax (10.63-9.98), CO (14.2-15.43), AHDsag (8-7.66), and AHDcor (7.65-7.68) measurements (operated side-healthy side, respectively) were statistically similar (p > 0.05). No statistically significant difference was found between TMC and STSN in healthy and operated shoulders (p > 0.05). There was mild coracoacromial ligament fraying in 4 (25%) and obvious coracoacromial ligament fraying in 8 (50%) which indicated subacromial impingement in 75% of the patients. DISCUSSION: The parameters of the coracoid process did not reveal any significant difference between the operated (for an isolated subscapularis tear) and opposite-side healthy shoulders of the patients. However, coracoacromial ligament degeneration was present in 75% of the patients.

摘要

背景:本研究旨在探讨当比较接受为特发性肩胛下肌撕裂病因的因素与接受关节镜下孤立性肩胛下肌撕裂修复术患者的对侧健康肩部时,这些因素是否为真正的病因。

方法:评估了 2016 年 2 月至 2018 年 1 月期间接受肩关节镜检查并诊断为孤立性肩胛下肌撕裂的 16 名患者。在 MRI 研究的轴位图像上评估喙肱距离(CHDax)、喙突重叠(CO)和结节下囊肿(TMC),在斜矢状位图像上评估肩峰肱骨头距离(AHDsag)、CHDsag 和肩胛下肌腱滑数(STSN),在斜冠状位图像上评估 AHDcor 和 SLAP 病变。关节镜检查时评估肩锁韧带的退变。

结果:CHDax(10.63-9.98)、CO(14.2-15.43)、AHDsag(8-7.66)和 AHDcor(7.65-7.68)的均值(患侧-健侧,分别)的测量值在统计学上无显著差异(p>0.05)。TMC 和 STSN 在健康和患侧肩部之间无统计学差异(p>0.05)。4 例(25%)有轻度肩锁韧带撕裂,8 例(50%)有明显肩锁韧带撕裂,表明 75%的患者有肩峰下撞击。

讨论:喙突参数在接受孤立性肩胛下肌撕裂修复术的患者的患侧与对侧健康肩部之间无明显差异。然而,75%的患者存在肩锁韧带退变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/97bcc44c2659/turkjmedsci-53-1-273f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/f03e538fa241/turkjmedsci-53-1-273f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/bcb423192a8f/turkjmedsci-53-1-273f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/fbefe512b223/turkjmedsci-53-1-273f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/d8a1018bce19/turkjmedsci-53-1-273f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/97bcc44c2659/turkjmedsci-53-1-273f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/f03e538fa241/turkjmedsci-53-1-273f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/bcb423192a8f/turkjmedsci-53-1-273f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/fbefe512b223/turkjmedsci-53-1-273f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/d8a1018bce19/turkjmedsci-53-1-273f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6f0/10387881/97bcc44c2659/turkjmedsci-53-1-273f5.jpg

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引用本文的文献

[1]
Which radiological parameters of the coracoid process influence the diagnosis of atraumatic subscapularis tears? Systematic review and meta-analysis.

Eur J Orthop Surg Traumatol. 2025-9-6

[2]
Analysis of the therapeutic efficacy of arthroscopic repair of the subscapularis tendon combined with coracoplasty.

Sci Rep. 2025-1-10

[3]
Magnetic resonance imaging based coracoid process morphology and its associations with isolated subscapularis tendon tears in Chinese patients.

Jt Dis Relat Surg. 2024-4-26

[4]
Clinical efficacy and tendon integrity of patients with subscapularis tear by the technique of arthroscopic single external row repair.

Front Med (Lausanne). 2023-7-25

本文引用的文献

[1]
Do subscapularis tears really result in superior humeral migration?

Acta Orthop Traumatol Turc. 2018-3

[2]
The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study.

J Orthop Sci. 2018-3

[3]
Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement.

Orthop J Sports Med. 2017-10-16

[4]
Current Concepts in the Diagnosis and Treatment of Shoulder Impingement.

Indian J Orthop. 2017

[5]
Diagnostic performance of clinical tests for subscapularis tendon tears.

Knee Surg Sports Traumatol Arthrosc. 2017-7-4

[6]
Redefining anterior shoulder impingement: a literature review.

Int Orthop. 2018-2

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Three-Dimensional Morphometric Analysis of the Coracohumeral Distance Using Magnetic Resonance Imaging.

Orthop Rev (Pavia). 2017-3-27

[8]
Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study.

Arthroscopy. 2017-4

[9]
Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity.

Knee Surg Sports Traumatol Arthrosc. 2016-11-5

[10]
Clinico-Radiological Correlation of Subcoracoid Impingement with Reduced Coracohumeral Interval and its Relation to Subscapularis Tears in Indian Patients.

J Clin Diagn Res. 2016-9

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