核磁共振肩关节参数评估冈上肌腱损伤程度

doi:10.3877/cma.j.issn.1674-134X.2023.02.004

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。

关键词: 回旋套损伤, 回旋套, 磁共振成像, 肩关节

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.

Key words: Rotator cuff injuries, Rotator cuff, Magnetic resonance imaging, Shoulder joint

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

组别Group	例数Number of cases	年龄Age [岁，(±s)]	性别(男/女) Gender (male/female)
非肩袖损伤组Non-rotator cuff injury group	37	57.7±1.9	23/14
冈上肌腱部分撕裂组Partial supraspinatus tendon tear group	37	58.3±1.3	14/23
冈上肌腱完全撕裂组Complete supraspinatus tendon tear group	28	62.5±1.3	15/13
统计值		F＝2.457	χ²＝4.484
P值		0.091	>0.05

表1 三组患者一般资料比较

Table 1 Comparison of general information among three groups

组别Group	例数Number of cases	年龄Age [岁，(±s)]	性别(男/女) Gender (male/female)
非肩袖损伤组Non-rotator cuff injury group	37	57.7±1.9	23/14
冈上肌腱部分撕裂组Partial supraspinatus tendon tear group	37	58.3±1.3	14/23
冈上肌腱完全撕裂组Complete supraspinatus tendon tear group	28	62.5±1.3	15/13
统计值		F＝2.457	χ²＝4.484
P值		0.091	>0.05

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

组别Group	例数Number of cases	肩峰厚度Acromial thickness (±s)	肩肱距Acromiohumeral distance (±s)	肱骨头上移距离Superior migration of humeral head M(P₂₅，P₇₅)
非肩袖损伤组Non-rotator cuff injury group	37	6.60±0.16	8.77±0.22	-0.25(-0.77，0)^b
冈上肌腱部分撕裂组Partial supraspinatus tendon tear group	37	8.24±0.19^a	7.85±0.21^c	0(0，0)^e
冈上肌腱完全撕裂组Complete supraspinatus tendon tear group	28	8.88±0.26^ab	5.89±0.31^ad	0.72(0，1.52)^a
统计值		F＝35.509	F＝34.629	H＝43.813
P值		<0.001^a	<0.001^a	<0.001^b

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

组别Group	例数Number of cases	肩峰厚度Acromial thickness (±s)	肩肱距Acromiohumeral distance (±s)	肱骨头上移距离Superior migration of humeral head M(P₂₅，P₇₅)
非肩袖损伤组Non-rotator cuff injury group	37	6.60±0.16	8.77±0.22	-0.25(-0.77，0)^b
冈上肌腱部分撕裂组Partial supraspinatus tendon tear group	37	8.24±0.19^a	7.85±0.21^c	0(0，0)^e
冈上肌腱完全撕裂组Complete supraspinatus tendon tear group	28	8.88±0.26^ab	5.89±0.31^ad	0.72(0，1.52)^a
统计值		F＝35.509	F＝34.629	H＝43.813
P值		<0.001^a	<0.001^a	<0.001^b

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

	肩峰厚度Acromial thickness	肩肱距Acromiohumeral distance	肱骨头上移距离Superior migration of humeral head
r值	0.636	-0.592	0.646
P值	<0.001	<0.001	<0.001

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

	肩峰厚度Acromial thickness	肩肱距Acromiohumeral distance	肱骨头上移距离Superior migration of humeral head
r值	0.636	-0.592	0.646
P值	<0.001	<0.001	<0.001

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Evaluation of supraspinatus tendon tear and changes in MRI shoulder parameters

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Evaluation of supraspinatus tendon tear and changes in MRI shoulder parameters