摘要
目的通过三维测量接受肩关节镜手术患者术前、术后肩峰前缘骨赘及肩峰形态,分析肩峰前缘骨赘在不同肩峰类型及肩袖损伤程度组间的差异,探讨肩峰前缘骨赘变化与年龄、肩峰形态及肩关节疾病的关系.方法选取上海交通大学医学院附属第九人民医院2016年10月至2018年5月进行肩关节镜手术患者129例.所有患者在关节镜下行肩峰成形术,手术前、后常规拍摄标准肩关节前后位、标准冈上肌出口位X线片及肩关节CT薄层平扫,经三维重建后在肩关节三维模型上测量手术前、后肩峰前缘骨赘距离(acromial spur distance,ASD)、肩峰倾斜角(acromial slope angle,ASA)及肩峰弧高度(acromial curvature height,ACH).结果术前ASD平均为(4.14±1.89)mm,ASA平均为24.73°±2.19°,ACH平均为(3.71±0.48)mm.研究对象年龄平均为(61.03±7.15)岁.Ⅰ型、Ⅱ型、Ⅲ型肩峰组间的年龄逐渐增大,呈显著正相关.ASD与年龄存在显著的正相关关系,P=0.014.ASD在Ⅲ型肩峰组及肩袖完全损伤组较其他组显著增大,差异有统计学意义.不同肩峰类型及肩袖损伤程度组间ASA及ACH没有差异.肩关节镜术后ASD显著减小,P<0.001.Ⅰ型和Ⅱ型肩峰组手术前、后ASA及ACH没有差异,而在Ⅲ型肩峰组则表现出显著的差异,P值分别为0.012及0.038.术后6个月Constant肩关节功能评分平均为(92.21±4.11)分,美国加州大学肩关节功能评分平均为(30.96±2.54)分,与术后ASD变化无相关性(P=0.427).结论数字化三维建立模型评估肩峰形态能提高测量的精度和广度.年龄仍然是预测肩峰形态及前缘骨赘的一个重要指标.ASD增大在Ⅲ型钩状肩峰中发生率较高并能改变肩峰原有形态,造成肩峰ASA及ACH增大,引起肩峰撞击及肩袖损伤风险增大.在Ⅲ型肩峰患者镜下手术时应常规行肩峰成形术并特别注意肩峰前缘骨赘的位置以确保恢复肩峰正常形态,而对于Ⅰ型及Ⅱ型肩峰患者镜下应酌情选择�
Background Acromial impingement syndrome is one of the most common causes of shoulder pain, and it can result in rotator cuff injury. Whether the underlying cause of this shoulder pain is the degenerative change of rotator cuff tendon or the impact of anterior acromial spur on acromion is still debatable. Many studies still cannot deny that external mechanical collision is one of the main causes of rotator cuff degeneration and shoulder pain. The acromial spur has been reported to be associated with acromial impingement and resulting rotator cuff injury and is considered to be formed by the contraction of acromiocoracoid ligament. The incidence of anterior acromial spur in the "hooked" acromion is higher than those of other types of acromion. Therefore,the anterior acromial spur may have a certain relationship with the morphological changes of acromion, acromial impingement and rotator cuff injury. The preoperative and postoperative evaluations of patient’s anterior acromial spur are beneficial to the diagnosis, treatment and rehabilitation guidance of shoulder joint disease.In this study, a three-dimensional morphological investigation was conducted on the preoperative and postoperative anterior acromial spurs and acromial morphology of patients who receive shoulder arthroscopic surgery. The following questions were discussed:(1) Whether the different types of acromion and the degree of rotator cuff injury were associated with acromial morphology, and whether the size of anterior acromial spur is related to age.(2) Whether the morphological changes of anterior acromial spur after acromioplasty can change the morphology of acromion, and whether it is related to the recovery of postoperative shoulder function.Methods 1. Research object: From October 2016 to May 2018, a total of 129 cases of shoulder arthroscopy were performed in the Department of Orthopaedic Sports Medicine of the Ninth People’s Hospital affiliated to Shanghai Jiaotong University. All patients underwent arthroscopic acromioplasty.The standard
作者
曾一鸣
王燎
徐辰
张凯
张峻
Zeng Yiming;Wang Liao;Xu Chen;Zhang Kai;Zhang Jun(Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011,China)
出处
《中华肩肘外科电子杂志》
2019年第2期136-144,共9页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
上海交通大学医工交叉项目(YG2017MS05)
上海市卫生和计划生育委员会项目(2017ZZ01023-002)
关键词
肩峰骨赘
肩峰倾斜角
肩峰弧高度
肩峰形态
三维测量
Acromial spur
Acromial slope angle
Acromial curvature height
Acromial morphology
Three-dimensional measurement
