肩关键角增大作为肩袖钙化性肌腱炎高危因素的研究

doi:10.3877/cma.j.issn.1674-134X.2025.06.003

目的

探讨肩关键角（CSA）与肩袖钙化性肌腱炎（CST）发生之间的关联，从临床和影像学两个角度分析CSA增大作为CST发病的潜在高危因素的可能性，为CST的早期诊断和精准治疗提供理论依据。

方法

回顾2017年6月至2024年1月期间在中国科学技术大学附属第一医院就诊的所有CST患者，其中术前未发现肩袖撕裂等其他肩关节疾病并接受了肩关节镜手术治疗者均纳入CST组，排除肩袖撕裂和曾接受过肩关节镜手术的患者，将等例数的本院同时期因锁骨骨折住院的患者与之匹配并纳入对照组。提取所有患者术前的肩关节正位X线片，由同一名研究者在间隔1个月的时间里分两次测量CSA。采用独立样本t检验对CST组和对照组的CSA值进行比较。将CST组患者按CSA大小分为不同亚组，分析CSA大小与患者术前以及术后1年肩关节疼痛视觉模拟量表（VAS）和美国肩肘外科协会评分（ASES）、美国加州大学肩关节评分（UCLA）等功能评分之间的关联。

结果

本研究共纳入100例患者，其中CST组和对照组各有50例可供分析。CST组患者的平均CSA（39.6±3.7）°，高于对照组的（34.5±1.5）°（t=8.97，P<0.001）。CST组CSA较大的患者在术前对应较高的疼痛评分和较差的功能评分（t=3.81，P<0.05）；术后，CST组患者的疼痛和功能评分均得到改善，不同CSA亚组之间患者的术后疼痛和功能评分差异无统计学意义（均为P>0.05）。CST组患者中Ⅲ型肩峰（钩型）占比达56%（28/50），而对照组仅12%（6/50），差异有统计学意义（χ²=21.58，P<0.001）。单纯清理组和肩峰成形组在术后VAS评分、ASES评分和UCLA评分差异无统计学意义（均为P>0.05）。患者是否行肩袖修补其术后评分与研究主变量（CSA与CST的关联）差异无统计学意义（均为P>0.05）。

结论

CST与增大的CSA之间存在关联，提示CSA增大可能是CST发生的高危因素。尽管CSA较大的CST患者在术前肩关节功能较差，但术后患者的疼痛和功能评分改善与小CSA患者相似。

关键词: 肩, 肩痛, 关节镜, 滑囊炎

Objective

To explore the association between critical shoulder angle (CSA) and calcific supraspinatus tendinitis (CST) in the rotator cuff, analyzing the possibility of CSA enlargement as a potential high-risk factor for CST from both clinical and imaging perspectives, and provide theoretical basis for early diagnosis and precise treatment of CST.

Methods

All CST patients who received treatment at the First Affiliated Hospital of the University of Science and Technology of China from June 2017 to January 2024 were included. The patients with no other shoulder joint diseases before surgery and undergoing arthroscopic shoulder surgery were enrolled in the CST group, while the patients with rotator cuff tears and history of shoulder surgery were excluded. An equal number of patients admitted to the hospital during the same period due to clavicle fractures were matched and included in the control group. The shoulder joint X-rays of all the patients before operation were extracted, and CSA was measured twice by the same researcher at one month interval. Independent sample t test was used to compare the CSA values of CST group and control group. The patients in CST group were divided into different subgroups according to CSA size, and the associations between visual analog scale (VAS) for shoulder pain and American Society of Shoulder and Elbow Surgeons (ASES), University of California shoulder score (UCLA) and other functional scoring systems scores before operation and at one year after operation were analyzed.

Results

A total of 100 patients were enrolled, with 50 cases in the CST group and 50 cases in the control group available for analysis. The average CSA in CST group (39.6±3.7) ° was higher than that of the control group (34.5±1.5) ° (t=8.97, P<0.001). Patients with larger CSA in the CST group had higher pain scores and poorer functional scores before surgery (t=3.81, P<0.05). After surgery, the pain and functional scores in the CST group were improved, and there were no statistically significant differences in the pain and functional scores among the different CSA subgroups (all P>0.05). The proportion of typeⅢ acromion (hook type) in the CST group was 56% (28/50), while only 12% (6/50) in the control group, the difference was statistically significant (χ²=21.58, P<0.001). There was no statistically significant difference in VAS, ASES, and UCLA scores between the two groups after surgery (all P>0.05).There was no statistically significant difference in VAS, ASES, and UCLA scores (all P>0.05) between the patients whether underwent rotator cuff repair.

Conclusions

There is a correlation between CST and increased CSA, suggesting that increased CSA may be a high-risk factor for CST occurrence. Although CST patients with larger CSA may have poorer shoulder joint function before surgery, pain and functional scores after surgery could still show similar improvements as the small CSA patients.

Key words: Shoulder, Shoulder pain, Arthroscope, Bursitis

图1 CST（肩袖钙化性肌腱炎）组CSA（肩关键角）测量方法示意图

Figure 1 Schematic diagram of measurement method for CST group CSA

图2 对照组CSA（肩关键角）测量方法示意图

Figure 2 Schematic diagram of the measurement method for CSA in the control group

图3 关节镜下肩峰成形术中肩峰成形

Figure 3 Intraoperative acromioplasty under arthroscope

图4 关节镜下肩钙化性肌腱炎冈上肌钙化灶

Figure 4 The calcified lesions in the supraspinatus muscle of shoulder calcified tendinitis under arthroscope

表1 研究对象的基线特征比较

Table 1 Comparison of baseline characteristics of research subjects

组别Groups	例数Number of cases	年龄[岁，（±s）]Age （year）	男性[n（%）]Male	BMI [kg/m²，（±s）]	左侧[n（%）]Left side
CST组CST group	50	53.2±10.3	4（8.0）	24.3±2.8	20（40.0）
对照组Control group	50	52.7±9.9	5（10.0）	24.1±2.7	22（44.0）
统计值Statistical values		χ²=0.21	t=0.01	χ²=0.29	t=0.04
P值		>0.05	>0.05	>0.05	>0.05

表1 研究对象的基线特征比较

Table 1 Comparison of baseline characteristics of research subjects

组别Groups	例数Number of cases	年龄[岁，（±s）]Age （year）	男性[n（%）]Male	BMI [kg/m²，（±s）]	左侧[n（%）]Left side
CST组CST group	50	53.2±10.3	4（8.0）	24.3±2.8	20（40.0）
对照组Control group	50	52.7±9.9	5（10.0）	24.1±2.7	22（44.0）
统计值Statistical values		χ²=0.21	t=0.01	χ²=0.29	t=0.04
P值		>0.05	>0.05	>0.05	>0.05

表2 不同CSA患者手术前后疼痛及功能评分比较[分，M（P₂₅，P₇₅）]

Table 2 Comparison on pain and function scores between two different CSA groups

组别Groups	例数Number of cases	VAS		ASES		UCLA
组别Groups	例数Number of cases	术前Before operation	术后After operation	术前Before operation	术后After operation	术前Before operation	术后After operation
CSA≥39.4°	35	8.5（8.0，8.5）	0（0，1.0）	28.2（21.6，28.6）	93.0（92.8，100.0）	10.0（9.0，11.0）	33.0（33.0，35.0）
CSA<39.4°	15	7.0（7.0，8.5）	0（0，1.0）	35.4（21.8，35.8）	100.0（93.0，100.0）	13.0（9.0，15.0）	35.0（33.0，35.0）
Z值		3.42	0.78	2.76	0.49	3.18	0.37
P值		<0.001	>0.05	0.006	>0.05	0.001	>0.05

表2 不同CSA患者手术前后疼痛及功能评分比较[分，M（P₂₅，P₇₅）]

Table 2 Comparison on pain and function scores between two different CSA groups

组别Groups	例数Number of cases	VAS		ASES		UCLA
组别Groups	例数Number of cases	术前Before operation	术后After operation	术前Before operation	术后After operation	术前Before operation	术后After operation
CSA≥39.4°	35	8.5（8.0，8.5）	0（0，1.0）	28.2（21.6，28.6）	93.0（92.8，100.0）	10.0（9.0，11.0）	33.0（33.0，35.0）
CSA<39.4°	15	7.0（7.0，8.5）	0（0，1.0）	35.4（21.8，35.8）	100.0（93.0，100.0）	13.0（9.0，15.0）	35.0（33.0，35.0）
Z值		3.42	0.78	2.76	0.49	3.18	0.37
P值		<0.001	>0.05	0.006	>0.05	0.001	>0.05

表3 肩峰形态分布比较[n（%）]

Table 3 Comparison of shoulder peak morphology distribution

组别Groups	例数Number of cases	Ⅰ型（扁平型）TypeⅠ(flat type)	Ⅱ型（曲线型）TypeⅡ(curve type)	Ⅲ型（钩型）TypeⅢ(hook type)
CST组CST group	50	8（16）	28（56）	28（56）
对照组Control group	50	28（56）	16（32）	6（12）
χ²值		11.111	3.031	14.235
P值		P<0.001	P<0.001	P<0.001

表3 肩峰形态分布比较[n（%）]

Table 3 Comparison of shoulder peak morphology distribution

组别Groups	例数Number of cases	Ⅰ型（扁平型）TypeⅠ(flat type)	Ⅱ型（曲线型）TypeⅡ(curve type)	Ⅲ型（钩型）TypeⅢ(hook type)
CST组CST group	50	8（16）	28（56）	28（56）
对照组Control group	50	28（56）	16（32）	6（12）
χ²值		11.111	3.031	14.235
P值		P<0.001	P<0.001	P<0.001

表4 肩峰成形组与单纯清理组术后评分[分，M（P₂₅，P₇₅）]

Table 4 Evaluation scores coparsion after surgery betweenacromioplasty group and debridement group

组别Groups	例数Number of cases	VAS	ASES	UCLA
成形组Acromioplasty group	38	0（0，1.0）	93.0（92.8，100.0）	33.0（33.0，35.0）
单纯清理组Debridement group	12	0（0，1.0）	100.0（93.0，100.0）	35.0（33.0，35.0）
Z值		0.265	0.354	0.597
P值		>0.05	>0.05	>0.05

表4 肩峰成形组与单纯清理组术后评分[分，M（P₂₅，P₇₅）]

Table 4 Evaluation scores coparsion after surgery betweenacromioplasty group and debridement group

组别Groups	例数Number of cases	VAS	ASES	UCLA
成形组Acromioplasty group	38	0（0，1.0）	93.0（92.8，100.0）	33.0（33.0，35.0）
单纯清理组Debridement group	12	0（0，1.0）	100.0（93.0，100.0）	35.0（33.0，35.0）
Z值		0.265	0.354	0.597
P值		>0.05	>0.05	>0.05

表5 是否行肩袖修补术后评分比较[分，M（P₂₅，P₇₅）]

Table 5 Evaluations on whether patients underwent rotator cuff repair surgery

肩袖修补术Rotator cuff repair surgery	例数Number of cases	VAS	ASES	UCLA
否No	36	0 （0，0.8）	100.0 （92.9，100.0）	35.0 （33.0，35.0）
是Yes	14	0 （0，2.0）	93.0 （92.8，100.0）	33.0 （33.0，35.0）
Z值		0.302	0.406	1.102
P值		>0.05	>0.05	>0.05

表5 是否行肩袖修补术后评分比较[分，M（P₂₅，P₇₅）]

Table 5 Evaluations on whether patients underwent rotator cuff repair surgery

肩袖修补术Rotator cuff repair surgery	例数Number of cases	VAS	ASES	UCLA
否No	36	0 （0，0.8）	100.0 （92.9，100.0）	35.0 （33.0，35.0）
是Yes	14	0 （0，2.0）	93.0 （92.8，100.0）	33.0 （33.0，35.0）
Z值		0.302	0.406	1.102
P值		>0.05	>0.05	>0.05

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[15]	赵金凤, 王凌毅, 姜东春. 体外冲击波刺激足三里及肩髃对糖尿病性胃轻瘫患者胃肠动力及自主神经功能的调节作用[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 539-545.

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Studies on critical shoulder angle enlargement as high-risk factor for calcific tendinitis of rotator cuff

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Studies on critical shoulder angle enlargement as high-risk factor for calcific tendinitis of rotator cuff