Jiang H, Yan Y, Li P, Chen K, Ma H, Zeng Y, Tang X, Cui G
Department of Orthopedics, Chengdu Second People ' s Hospital, Affiliated Hospital of Chengdu Medical College, Chengdu 610017, China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):740-747. doi: 10.19723/j.issn.1671-167X.2025.04.018.
The greater tuberosity angle (GTA) and critical shoulder angle (CSA) are commonly referred to as radiographic markers which were used to described morphology of the greater tuberosity and acromion respectively. At present, most international studies focus on the correlation between the above two parameters and rotator cuff tears (RCTs), and their diagnostic value and risk assessment. This study attempts to find out the trend of GTA and CSA changes and risk threshold of RCTs, as well as the protective factors and risk factors.
In this study, 130 individuals from May 2019 to December 2020 were recruited. According to Southern California Orthopedic Institute (SCOI) classification, the individuals were divided into four groups retrospectively: Group A, negative control group; Group B, partial tears (articular side); Group C, partial tears (bursal side); Group D, full-thickness tears. GTA and CSA were measured respectively on true anteroposterior position X-ray of shoulder with arm in neutral rotation and performed by the same trained technician team in single-blind. The correlations between RCTs and relevant factors were analyzed.
According to the area under the receiver operating characteristic curve (AUC), GTA and CSA of RCTs (Groups B, C and D) were 0.736 and 0.673 with 95% confidence interval (), the cut-off value of GTA and CSA of RCTs were 70.5° and 39.5° respectively. Comparing with the control group, RCTs groups had significant statistical differences in age and body mass index (BMI) ( < 0.05), especially the full-thickness RCTs (Group D), which was older than Groups A, B and C ( < 0.05, cut-off value: 56.5 years old) and shorter than Groups A and B ( < 0.05, cut-off value: 1.58 m). Analyzed from scatter plot and regression analysis, there was no linear correlation between GTA and CSA. There were no significant differences in gender, dominant shoulders and smoking between the RCTs groups and the control group (>0.05).
Larger GTA (>70.5°) and CSA (>39.5°) would be highly predictive in diagnosing RCTs without linear correlation, and GTA has a higher diagnostic value in contrast. Subacromial impingement and shoulder degeneration occurred before RCTs. Patients with age >56.5 years and height < 1.58 m were more likely to develop disease of full-thickness RCTs and no statistic differences in weight and BMI. Gender, dominant shoulder and smoking were neither risk factors nor protective factors.
大结节角（GTA）和临界肩角（CSA）通常被视为影像学标记，分别用于描述大结节和肩峰的形态。目前，大多数国际研究聚焦于上述两个参数与肩袖撕裂（RCTs）之间的相关性、它们的诊断价值及风险评估。本研究试图找出GTA和CSA的变化趋势以及RCTs的风险阈值，还有保护因素和风险因素。
本研究招募了2019年5月至2020年12月期间的130名个体。根据南加州骨科研究所（SCOI）分类，将这些个体回顾性地分为四组：A组，阴性对照组；B组，部分撕裂（关节侧）；C组，部分撕裂（滑囊侧）；D组，全层撕裂。在肩部真正的前后位X射线上，于手臂中立旋转位分别测量GTA和CSA，由同一组经过培训的技术人员以单盲方式进行操作。分析RCTs与相关因素之间的相关性。
根据受试者操作特征曲线（AUC）下的面积，RCTs组（B、C和D组）的GTA和CSA分别为0.736和0.673，95%置信区间（），RCTs的GTA和CSA的截断值分别为70.5°和39.5°。与对照组相比，RCTs组在年龄和体重指数（BMI）方面有显著统计学差异（<0.05），尤其是全层RCTs组（D组），其年龄大于A、B和C组（<0.05，截断值：56.5岁），身高低于A组和B组（<0.05，截断值：1.58米）。从散点图和回归分析来看，GTA和CSA之间无线性相关性。RCTs组与对照组在性别、优势肩和吸烟方面无显著差异（>0.05）。
较大的GTA（>70.5°）和CSA（>39.5°）对诊断RCTs具有较高的预测性且无线性相关性，相比之下GTA具有更高的诊断价值。肩峰下撞击和肩部退变发生在RCTs之前。年龄>56.5岁且身高<1.58米的患者更易发生全层RCTs疾病，在体重和BMI方面无统计学差异。性别、优势肩和吸烟既不是风险因素也不是保护因素。
