探索计算机灰度平均值对冈上肌腱病患者的评估作用。

纳入广州医科大学附属第五医院康复科治疗的单侧冈上肌腱病患者46例，排除双侧肩痛和其他非肌腱因素所致的肩痛患者。按性别分为男性组16例、女性组30例；按年龄分为青壮年组10例、中年组19例、老年组17例；按病程分为急性期组13例、慢性期组19例、慢性迁延期组14例。触诊冈上肌腱行VAS评分并定位标记主要压痛点和次要压痛点。以改良Crass体位对冈上肌腱行超声摄片，对主要及次要压痛点短轴图行患侧健侧等面积截图，行计算机灰度分析测其灰度平均值。采用配对t检验，比较主要压痛点和次要压痛点，患侧和健侧灰度平均值的差异；采用单因素方差分析，比较不同性别、年龄、病程组间，主要压痛点和次要压痛点灰度平均值的差异。采用计算机灰度分析方法定量评价超声视觉评估无特异性病变的冈上肌腱压痛点回声差异。

冈上肌腱存在多个压痛点，根据VAS评分可分为主要和次要压痛点。女性主压痛点VAS评分高于男性(t＝2.175，P<0.05)，老年组主压痛点VAS评分高于中年组和青壮年组(F＝3.851，P<0.05)。冈上肌腱主要及次要压痛点灰度平均值均小于健侧(t＝8.109、4.816，均为P<0.001)。患侧冈上肌腱，按年龄性别或者病程分组，主要压痛点灰度平均值较健侧均明显下降(P<0.05)。健侧冈上肌腱，其灰度平均值女性低于男性(t＝3.881，P<0.001)，老年组低于中年组和青壮年组(F＝14.000，P<0.001)。

冈上肌腱病常有多个压痛点，需要对所有压痛点进行超声检查。对于超声视觉评估无特征性征象的冈上肌腱压痛点，灰度平均值较健侧下降可提示冈上肌腱病，此方法可量化肩袖肌腱病变程度，有望为该病的诊断提供参考依据。

To explore the evaluation effect of computer grayscale analysis value on patients with supraspinatus tendinopathy.

Forty-six patients with unilateral supraspinatus tendinopathy in the rehabilitation department of the Fifth Affiliated Hospital of Guangzhou Medical University were selected. The patients with shoulder pain caused by bilateral shoulder pain and other non-tendon factors were excluded. According to gender, age, disease course, the patients were divided into the male group (16 cases) and the female group (30 cases), or the young adults group (10 cases), the middle-age group (19 cases), the elderly group (17 cases), and the acute phase group (13 cases), the chronic phase group (19 cases), the chronic prolongation group (14 cases). The supraspinatus tendon was palpated for visual analogue scale (VAS) scoring and locating the primary and secondary trigger points. Ultrasound short axis radiographs of the supraspinatus tendon were acquired in the Crass posture. The screenshot of the main and secondary trigger points was taken on the affected side and healthy side with equal-area and their grayscale values were measured by computer gray analysis. The paired t test was used to compare the grayscale values of the affected side and the healthy side, as well as the main and secondary trigger points. Single factor analysis of variance was used to compare the grayscale values on the main and secondary trigger points between different genders, ages, and disease courses. The computer grayscale analysis method was used to quantitatively evaluate the echo difference of supraspinatus trigger points.

There were multiple trigger points on the supraspinatus tendon, which could be divided into primary and secondary trigger points according to the VAS score. The VAS score of main trigger points in the female group was higher than that in the male group (P=0.035). The VAS score of main trigger point in the elderly group was higher than that in middle-age group and the young adults group (P<0.05). The grayscale value of the main and secondary trigger points of the supraspinatus tendon was less than that of the healthy side (t=8.109, 4.816, both P<0.001). Grouping by gender, disease course or ages, the grayscale values on the affected side were significantly lower than those on the healthy side (all P<0.05). The grayscale value of the healthy side in females was lower than that in males (t=3.881, P<0.001), which was lower in the elderly group than that in the middle-age group and the young adults group (F=14.000, P<0.001).

The supraspinatus tendon is a disease that often has multiple trigger points, and ultrasound examination of all trigger points is required. For visual evaluation of supraspinatus tenderness points with no characteristic signs, a decrease in the grayscale average compared to the healthy side may indicate supraspinatus tendinopathy. This method can quantify the degree of rotator cuff tendinopathy and is expected to provide a reference for the diagnosis of the disease.