切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 173 -178. doi: 10.3877/cma.j.issn.1674-134X.2023.02.004

临床论著

核磁共振肩关节参数评估冈上肌腱损伤程度
王普, 秦江辉, 陈东阳, 杨献峰, 蒋青()   
  1. 210008 南京大学医学院附属鼓楼医院骨科,运动医学与成人重建外科,国家骨科与运动康复临床医学研究中心分中心
    210008 南京大学医学院附属鼓楼医院医学影像科
  • 收稿日期:2022-10-12 出版日期:2023-04-01
  • 通信作者: 蒋青
  • 基金资助:
    国家自然科学基金项目(81972124,82202755)

Evaluation of supraspinatus tendon tear and changes in MRI shoulder parameters

Pu Wang, Jianghui Qin, Dongyang Chen, Xianfeng Yang, Qing Jiang()   

  1. Department of Orthopedic Surgery, Division of Sports Medicine and Reconstructive Surgery, Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2022-10-12 Published:2023-04-01
  • Corresponding author: Qing Jiang
引用本文:

王普, 秦江辉, 陈东阳, 杨献峰, 蒋青. 核磁共振肩关节参数评估冈上肌腱损伤程度[J/OL]. 中华关节外科杂志(电子版), 2023, 17(02): 173-178.

Pu Wang, Jianghui Qin, Dongyang Chen, Xianfeng Yang, Qing Jiang. Evaluation of supraspinatus tendon tear and changes in MRI shoulder parameters[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 173-178.

目的

分析肩关节磁共振(MRI)肩峰厚度、肩肱距、肱骨头上移距离与冈上肌腱损伤严重程度的关系。

方法

回顾性分析2020年7月至2022年6月在南京大学医学院附属鼓楼医院行肩关节MRI检查者102例,排除肩关节手术、肩关节感染、肩部肿瘤史,肩关节骨性结构异常等患者。按有无冈上肌腱撕裂及其撕裂程度分为非肩袖损伤组37例、冈上肌腱部分撕裂组37例、冈上肌腱完全撕裂组28例,在斜矢状面上测量肩峰厚度、肩肱距、肱骨头上移距离,采用单因素方差分析或秩和检验分析其在3组间的差异并采用Spearman等级相关分析,判定其与冈上肌腱损伤程度之间的相关性。

结果

肩峰厚度平均值,非肩袖损伤组、冈上肌腱部分撕裂组、冈上肌腱完全撕裂组分别为:(6.60±0.16)mm、(8.24±0.19)mm、(8.88±0.26)mm,三组之间两两比较差异均有统计学意义(F=35.509, P<0.05),肩峰厚度与冈上肌腱损伤程度具有正相关性(r=0.636,P<0.001)。肩肱距平均值,非肩袖损伤组、冈上肌腱部分撕裂组、冈上肌腱完全撕裂组分别为:(8.77±0.22)mm、(7.85±0.21)mm、(5.89±0.31)mm,三组之间两两比较差异均有统计学意义(F=34.629, P<0.05);肩肱距与冈上肌腱损伤程度成负相关(r=-0.592,P<0.001)。肱骨头上移距离结果:非肩袖损伤组、冈上肌腱部分撕裂组、冈上肌腱完全撕裂组分别为:-0.25(-0.77,0)mm、0(0,0)mm、0.72(0,1.52)mm,三组之间成对比较差异均有统计学意义(H=43.813, P<0.05),肱骨头上移距离与冈上肌腱损伤程度具有正相关性(r=0.646,P<0.001)。

结论

MRI测量的肩峰厚度、肩肱距、肱骨头上移距离与冈上肌腱撕裂程度具有相关性;随着冈上肌腱撕裂程度的增大,肩峰厚度增大,肩肱距减小,肱骨头上移距离增大。

Objective

To evaluate the relationship between severity of supraspinatus tendon tear and the thickness of acromion, acromiohumeral interval and superior migration of humeral head measured by magnetic resonance imaging (MRI).

Methods

A retrospective analysis was performed on 102 patients who underwent shoulder MRI scans, from July 2020 to June 2022, at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Patients with history of surgery, infection, tumour and abnormal bone structure of shoulder were excluded. According to the condition of supraspinatus tendon, the patients were divided into a non-rotator cuff injury group (37 patients), a partial supraspinatus tendon tear group (37 patients) and a complete supraspinatus tendon tear group (28 patients). The thickness of acromion, acromiohumeral interval and distance of superior migration of humeral head were measured on the oblique sagittal plane. Differences between the groups were analysed. Spearman correlation analysis was used to evaluate the relationship between the degree of supraspinatus tendon tear and the acromial thickness, acromiohumeral interval and superior migration of humeral head.

Results

The average thickness of acromion in non-rotator cuff injury group, partial supraspinatus tendon tear group and complete supraspinatus tendon tear group were found at (6.60±0.16) mm, (8.24±0.19) mm and (8.88±0.26) mm, respectively and there were statistical differences between the three groups (F=35.509, P<0.05). There was a significant positive correlation between the thickness of acromion and the degree of supraspinatus tendon tear (r=0.636, P<0.001). The average acromiohumeral interval in non-rotator cuff injury group, partial supraspinatus tendon tear group and complete supraspinatus tendon tear group were found at (8.77±0.22) mm, (7.85±0.21) mm and (5.89±0.31) mm, respectively. Pairwise comparisons among the three groups were statistically significant (F=34.629, P<0.05). There was a negative correlation between an acromiohumeral interval and the degree of supraspinatus tendon tear (r=-0.592, P<0.001). The results of distance of superior migration of humeral head in non-rotator cuff injury group, partial supraspinatus tendon tear group and complete supraspinatus tendon tear group were -0.25 (-0.77, 0) mm, 0 (0, 0) mm and 0.72 (0, 1.52) mm, respectively. There were statistical differences between the three groups (H=43.813, P<0.05). It was found that there was a significant positive correlation between the superior migration of humeral head and the degree of supraspinatus tendon tear (r=0.646, P<0.001).

Conclusions

The thickness of acromion, acromiohumeral interval and superior migration of humeral head measured by MRI were correlated with the severity of supraspinatus tendon tear. It has been found that as a supraspinatus tendon tear is getting aggravated, there will be an increase in the thickness of acromion and the distance of superior migration of humeral head and together with a decrease of acromiohumeral interval.

图3 肱骨头上移距离测量示意图
Figure 3 Measurement of the superior migration of humeral head on MRI
表1 三组患者一般资料比较
Table 1 Comparison of general information among three groups
表2 肩峰厚度、肩肱距、肱骨头上移距离的比较(mm)
Table 2 Comparison of acromial thickness, acromiohumeral interval and superior migration of humeral head
表3 冈上肌腱损伤程度与肩峰厚度、肩肱距、肱骨头上移距离的Spearman相关分析
Table 3 Spearman correlation analysis of supraspinatus tendon tear and acromial thickness, acromiohumeral interval and superior migration of humeral head
[1]
Lewis JS. Rotator cuff tendinopathy[J]. Br J Sports Med, 2009, 43(4): 236-241.
[2]
胡健,丁惠锋,姜新华,等. 肩袖层裂损伤的原因分析及治疗[J/CD]. 中华关节外科杂志(电子版), 2021, 15(4): 487-491.
[3]
Abrams GD, Luria A, Carr RA, et al. Association of synovial inflammation and inflammatory mediators with glenohumeral rotator cuff pathology[J]. J Shoulder Elbow Surg, 2016, 25(6): 989-997.
[4]
MacKenzie TA, Herrington L, Horlsey I, et al. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: is it important and what influences it?[J]. Clin Biomech, 2015, 30(7): 641-648.
[5]
McCreesh K, Crotty J, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review[J]. Br J Sports Med, 2015, 49(5): 298-305.
[6]
Roy JS, Braēn C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis[J]. Br J Sports Med, 2015, 49(20): 1316-1328.
[7]
殷钦,成欣,李云龙,等. 肩肱距减小与肩袖损伤相关性的研究[J/CD]. 中华肩肘外科电子杂志2018, 6(1): 25-29.
[8]
Saupe N, Pfirrmann CWA, Schmid MR, et al. Association between rotator cuff abnormalities and reduced acromiohumeral distance[J]. AJR Am J Roentgenol, 2006, 187(2): 376-382.
[9]
Xu M, Li Z, Zhou Y, et al. Correlation between acromiohumeral distance and the severity of supraspinatus tendon tear by ultrasound imaging in a Chinese population[J/OL]. BMC Musculoskelet Disord, 2020, 21(1): 106. DOI: 10.1186/s12891-020-3109-8.
[10]
Goutallier D, Le Guilloux P, Postel JM, et al. Acromio humeral distance less than six millimeter: its meaning in full-thickness rotator cuff tear[J]. Orthop Traumatol Surg Res, 2011, 97(3): 246-251.
[11]
Gruber G, Bernhardt GA, Clar H, et al. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability[J]. J Shoulder Elbow Surg, 2010, 19(1): 10-13.
[12]
Jeon YD, Yoon JY, Jeong HJ, et al. Significance of the acromiohumeral distance on stress radiography for predicting healing and function after arthroscopic repair of massive rotator cuff tears[J/OL]. J Shoulder Elbow Surg, 2021, 30(8): e471-e481. DOI: 10.1016/j.jse.2020.10.029.
[13]
Kum DH, Kim JH, Park KM, et al. Acromion index in Korean population and its relationship with rotator cuff tears[J]. Clin Orthop Surg, 2017, 9(2): 218-222.
[14]
Bernhardt GA, Glehr M, Zacherl M, et al. Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs[J]. Eur J Orthop Surg Traumatol, 2013, 23(2): 185-190.
[15]
Fehringer EV, Rosipal CE, Rhodes DA, et al. The radiographic acromiohumeral interval is affected by arm and radiographic beam position[J]. Skeletal Radiol, 2008, 37(6): 535-539.
[16]
McCrum E. MR imaging of the rotator cuff[J]. Magn Reson Imaging Clin N Am, 2020, 28(2): 165-179.
[17]
Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report[J]. J Bone Joint Surg Am, 1972, 54(1): 41-50.
[18]
Ogawa K, Yoshida A, Inokuchi W, et al. Acromial spur: relationship to aging and morphologic changes in the rotator cuff[J]. J Shoulder Elbow Surg, 2005, 14(6): 591-598.
[19]
Kim JH, Min YK, Gwak HC, et al. Rotator cuff tear incidence association with critical shoulder angle and subacromial osteophytes[J]. J Shoulder Elbow Surg, 2019, 28(3): 470-475.
[20]
Oh JH, Kim JY, Lee HK, et al. Classification and clinical significance of acromial spur in rotator cuff tear: heel-type spur and rotator cuff tear[J]. Clin Orthop Relat Res, 2010, 468(6): 1542-1550.
[21]
Kaur R, Dahuja A, Garg S, et al. Correlation of acromial morphology in association with rotator cuff tear: a retrospective study[J/OL]. Pol J Radiol, 2019, 84: e459-e463. DOI: 10.5114/pjr.2019.90277.
[22]
Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction[J]. Clin Orthop Relat Res, 1978(135): 165-170.
[23]
Mura N, O' Driscoll SW, Zobitz ME, et al. The effect of infraspinatus disruption on glenohumeral torque and superior migration of the humeral head: a biomechanical study[J]. J Shoulder Elbow Surg, 2003, 12(2): 179-184.
[24]
Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation[J]. Clin Orthop Relat Res, 1990(254): 92-96.
[25]
Keener JD, Wei AS, Kim HM, et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears[J]. J Bone Joint Surg (Am), 2009, 91(6): 1405-1413.
[26]
Plessers K, Verhaegen F, Van Dijck C, et al. Automated quantification of glenoid bone defects using 3-dimensional measurements[J]. J Shoulder Elbow Surg, 2020, 29(5):1050-1058.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[2] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[3] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[4] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[5] 吴少敏, 张世豪, 刘炳光, 李婵, 尹嘉敏, 郑昌业, 黄素然. 胎儿巨大蛛网膜囊肿并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 390-397.
[6] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[7] 刘明辉, 葛方明. MRI 对腹股沟疝修补术后患者早期并发症的评估价值研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 579-583.
[8] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[9] 曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[10] 王友健, 陶然, 陆跃, 马洪冬. 退行性中、小型肩袖撕裂两种临床治疗效果对比[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 302-308.
[11] 陈天鑫, 杨胜平, 朱瑜琪, 高云, 张帅. 多种手术方式治疗肩关节前向不稳定伴关节盂骨缺损的网状Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 344-352.
[12] 张琛朋, 王靖, 曾塬杰, 高鹏, 陈昕彤. 反式全肩关节置换术的研究进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 373-376.
[13] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
[14] 欧阳川, 朱巧珍, 欧阳林. 腰椎间盘退变的生物代谢特征及评价技术研究进展[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 206-211.
[15] 金安松, 邹玉松, 刘玖涛, 薛凤麟, 庞爱兰. 孤立性颅内浆细胞瘤一例及相关文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 495-500.
阅读次数
全文


摘要