Zhang Wen-Bin, Lu Fei-Long, Ma Yu-Lin, Du Xiao-Ming, Song Hao, Yang Zhao-Xi, Hu Yi-Mei
Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
Qionglai Hospital of Traditional Chinese Medicine, Chengdu, 611530, China.
BMC Musculoskelet Disord. 2025 Aug 23;26(1):815. doi: 10.1186/s12891-025-09086-w.
To investigate the relationships among the acromial tilt (AT), the glenoid inclination angle (GIA), the critical shoulder angle (CSA), the acromioglenoid angle (AGA), and degenerative rotator cuff injury via digital reconstruction radiographs (DRRs).
A retrospective cohort of 63 patients who met the inclusion criteria were enrolled from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between April 2023 and April 2024, 33 patients with rotator cuff injury and 30 controls were included. Clinical data and scapular computed tomography (CT) scans were collected, and three-dimensional reconstructions were generated via Amira software (Thermo Fisher Scientific, USA). Digital reconstruction radiograph (DRR) images were simulated at the Grashey and Y positions of the scapula, and the parameters were measured via Digimizer software (MedCalc Software, Belgium). The diagnostic and predictive validity of each parameter for DRR for rotator cuff injury was assessed through statistical analysis of the measured data, including inter-observer consistency, correlation analysis among parameters, and receiver operating characteristic (ROC) curve analysis.
(1) Inter-observer reliability was excellent for all the parameters (intra-class correlation coefficient (ICC) > 0.8). (2) CSA and AGA were significantly greater in the rotator cuff injury group (P= 0.003;P < 0.001), whereas GIA was significantly lower (P < 0.001); no difference was detected in AT (P > 0.05). (3) Binary logistic regression analysis revealed that GIA, CSA, and AGA were risk factors for rotator cuff injury (P=0.008; P = 0.001; P = 0.001). (4) ROC analysis yielded area under the curve (AUC) values of 0.755 (GIA), 0.700 (CSA), and 0.796 (AGA), with cutoff thresholds of 83.98°, 30.67°, and 42.04°, respectively. (5) Strong correlations were observed between the CSA and AGA (r = 0.939), whereas the GIA was inversely correlated with both the CSA (r = -0.423) and the AGA (r = -0.471).
Measurements of GIA, CSA, and AGA derived from DRRs demonstrate high diagnostic value for degenerative rotator cuff injury. DRR represents a reliable alternative to conventional radiography in clinical practice. In the future, DRR holds promise as a tool for assessing the impact of degenerative rotator cuff injury. However, due to radiation exposure concerns, the current application of DRR is recommended primarily for retrospective studies utilizing existing computed tomography (CT) data.
通过数字重建X线片（DRR）研究肩峰倾斜度（AT）、关节盂倾斜角（GIA）、临界肩角（CSA）、肩峰关节盂角（AGA）与退变性肩袖损伤之间的关系。
回顾性队列研究，选取2023年4月至2024年4月在成都中医药大学附属医院符合纳入标准的63例患者，其中肩袖损伤患者33例，对照组30例。收集临床资料和肩胛骨计算机断层扫描（CT）图像，通过Amira软件（美国赛默飞世尔科技公司）进行三维重建。在肩胛骨的Grashey位和Y位模拟数字重建X线片（DRR）图像，使用Digimizer软件（比利时MedCalc软件公司）测量相关参数。通过对测量数据进行统计分析，包括观察者间一致性、参数间相关性分析以及受试者工作特征（ROC）曲线分析，评估DRR各参数对肩袖损伤的诊断和预测效度。
（1）所有参数的观察者间可靠性均极佳（组内相关系数（ICC）>0.8）。（2）肩袖损伤组的CSA和AGA显著更大（P = 0.003；P < 0.001），而GIA显著更低（P < 0.001）；AT无差异（P > 0.05）。（3）二元逻辑回归分析显示，GIA、CSA和AGA是肩袖损伤的危险因素（P = 0.008；P = 0.001；P = 0.001）。（4）ROC分析得出曲线下面积（AUC）值分别为0.755（GIA）、0.700（CSA）和0.796（AGA），截断阈值分别为83.98°、30.67°和42.04°。（5）CSA与AGA之间存在强相关性（r = 0.939），而GIA与CSA（r = -0.423）和AGA（r = -0.471）均呈负相关。
DRR测量得出的GIA、CSA和AGA对退变性肩袖损伤具有较高的诊断价值。在临床实践中，DRR是传统X线摄影的可靠替代方法。未来，DRR有望成为评估退变性肩袖损伤影响的工具。然而，出于辐射暴露的考虑，目前建议DRR主要用于利用现有计算机断层扫描（CT）数据的回顾性研究。
