| 肩峰形态影像学分型在肩袖损伤诊治中的应用价值研究 |
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投稿时间：2021-10-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 朱迎春 |
ZHU Ying-chun |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 贾学文 |
JIA Xue-wen |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
nbspine@163.com |
| 宓云峰 |
MI Yun-feng |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 朱玉峰 |
ZHU Yu-feng |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 金占萍 |
JIN Zhan-ping |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 夏冬冬 |
XIA Dong-dong |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 顾春晓 |
GU Chun-xiao |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 张继红 |
ZHANG Ji-hong |
宁波市第一医院统计室, 浙江 宁波 315010 |
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| 王毳 |
WANG Cui |
宁波市第一医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第8期，第757-762页 |
| DOI：10.12200/j.issn.1003-0034.2022.08.011 |
| 基金项目:浙江省医药卫生科技项目（编号：2019KY165） |
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中文摘要:
目的：提出一种肩峰撞击理论以及肩关节Rockwood位片的肩峰形态分型法，探讨该分型法在肩袖损伤诊治中的应用价值。
方法：回顾性分析2017年1月至2017年12月因肩峰撞击症或肩袖撕裂行肩关节镜手术的101例患者，其中男34例，女67例；年龄34~76（56.31±9.63）岁；病程2~12个月，平均6个月。术前常规拍摄肩关节"三位片"，包括肩关节前后位、Rockwood位以及冈上肌Outlet位。基于肩峰撞击理论以及Rockwood位片将肩峰形态分为3型：Ⅰ型（平坦型）、Ⅱ型（隆起型）、Ⅲ型（撞击型）。两位观察者分别对101例患者的肩关节Rockwood位片按照新分型法、对冈上肌Outlet位片按照传统肩峰形态分型法进行分类统计；冈上肌腱损伤依据关节镜下所见分为无撕裂、部分撕裂、全层撕裂。分别对新分型法、传统分型法进行一致性检验（Kappa值），采用秩和检验比较新肩峰分型法3种肩峰形态的平均肩肱距（acromiohumeral distance，AHD），采用Spearman秩相关性检验以及Gamma法分析比较新肩峰分型法与冈上肌腱撕裂程度之间的相关性。
结果：观察者间一致性检验新肩峰分型法优于传统肩峰分型法（0.827 vs 0.278），观察者内一致性检验新肩峰分型法均优于传统肩峰分型法（0.921 vs 0.448，0.890 vs 0.539）。新的肩峰形态分型法3种肩峰形态的AHD比较差异无统计学意义（H=2.186，P>0.05）。所有101例患者撞击型肩峰占比最高为45.5%，隆起型肩峰次之36.6%，平坦型肩峰占17.8%。其中撞击型肩峰患者冈上肌腱撕裂发生率为95.7%，新的肩峰分型法与冈上肌腱撕裂程度存在Spearman秩相关（rs=0.719，P<0.001）。
结论：肩关节Rockwood位片可以很好的显示肩峰前外侧骨赘，基于Rockwood位片新肩峰分型法可信度高，可重复性良好，其中撞击型肩峰与冈上肌腱撕裂存在密切关联。新分型法相比传统分型以及AHD对肩袖损伤更具诊疗价值。 |
| 【关键词】肩撞击综合征 肩袖撕裂 肩峰形态 肩峰骨赘 关节镜 |
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| Clinical application of acromion radiological classification in diagnosis and treatment of rotator cuff injury |
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ABSTRACT
Objective: To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear.
Methods: The clinical data of 101 patients underwent shoulder arthroscopic surgery for impingement syndrome or rotator cuff tear from January to December 2017 were retrospectively analyzed. There were 34 males and 67 females, aged from 34 to 76 years with an average of (56.31±9.63) years old, course of disease from 2 to 12 months with average of 6 months. Preoperative radiographs of the routine anteroposterior view, Rockwood tilt view and the supraspinatus outlet view were obtained. Based on the subacromial impingement theory and Rockwood radiographs, the morphology of the acromion can be divided into three types:typeⅠ(flat type), typeⅡ(bump type), and type Ⅲ (impingement type). Two observers classified 101 shoulder Rockwood radiographs according to the new classification method and the supraspinatus Outlet radiographs according to the traditional acromial morphological classification method. Supraspinatus tendon injuries were classified into no tear, partial-thickness tear, and full-thickness tear according to the arthroscopic findings. Concordance test (Kappa value) between the inter-observer and intra-observer was carried out for the new classification method and the traditional classification method respectively. The rank sum test was used to compare the mean acromiohumeral distance(AHD) of the three acromion forms in the new acromion classification method. Spearman rank correlation test and Gamma method were used to analyze the correlation between the new acromion classification method and the degree of supraspinatus tendon tear.
Results: The inter-observer consistency analysis of the new classification system was significantly better than that of the traditional classification (0.827 vs 0.278), the intra-observer consistency analysis of the new classification system were also significantly better than that of the traditional classification (0.921 vs 0.448, 0.890 vs 0.539). There was no statistical significance in the AHD among three types of the new classification(H=2.186, P>0.05). In all 101 patients, the highest proportion of impingement type acromion was 45.5% (46 cases), followed by bump type acromion was 36.6% (37 cases), and flat type acromion was 17.8% (18 cases). The incidence of supraspinatus tendon tear in the patients with impingement type acromion was significantly higher than that of the other two types of acromion, there was a spearman rank correlation between the new acromion type and the degree of the supraspinatus tendon tear(rs=0.719, P<0.001).
Conclusion: Rockwood radiographs of the shoulder can well display the anterolateral osteophytes of the acromion. The new acromion classification method based on Rockwood radiographs has high reliability and good reproducibility, in which impingement type of acromion is closely related to supraspinatus tendon tear. Compared with the traditional classification and AHD, the new classification method has more diagnostic value than for rotator cuff injury. |
| KEY WORDS Shoulder impingement syndrome Rotator cuff tear Acromion morphology Acromion spur Arthroscopes |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱迎春,贾学文,宓云峰,朱玉峰,金占萍,夏冬冬,顾春晓,张继红,王毳.肩峰形态影像学分型在肩袖损伤诊治中的应用价值研究[J].中国骨伤,2022,35(8):757~762 |
| 英文格式: | ZHU Ying-chun,JIA Xue-wen,MI Yun-feng,ZHU Yu-feng,JIN Zhan-ping,XIA Dong-dong,GU Chun-xiao,ZHANG Ji-hong,WANG Cui.Clinical application of acromion radiological classification in diagnosis and treatment of rotator cuff injury[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(8):757~762 |
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