摘要目的 探讨肩峰指数、关节盂倾斜度与肩关节镜手术后功能恢复的关系。方法 选取2016年9月至2018年9月在北京中医药大学东方医院和北京中医药大学东直门医院骨科行肩关节镜手术的50例患者作为研究对象,其中男27例,女23例;年龄30~75岁,平均年龄(55.70±13.04)岁;左肩21例,右肩29例。术前及术后12个月均接受X线摄片、MRI及CT检查,并采用肩关节Constant-Murley评分及加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分,评估患者肩关节功能情况。采用Pearson检验分析影像学检查相关指标,分析肩关节盂形态学参数分别与Constant-Murley、UCLA评分的相关关系。结果 术后12个月的肩峰指数、肩峰角、喙肩韧带厚度、肩锁关节骨赘高度及肩关节盂高度、宽度、倾斜角均显著小于术前(P<0.05),肩肱间距及肩关节盂扭转角明显大于术前(P<0.05)。术后12个月Constant-Murley及UCLA评分均显著高于术前(P<0.05)。肩峰指数、肩峰角、喙肩韧带厚度、肩锁关节骨赘高度及肩关节盂高度、宽度、倾斜角分别与Constant-Murley、UCLA评分呈负相关(P<0.05),肩肱间距及肩关节盂扭转角分别与Constant-Murley、UCLA评分呈正相关(P<0.05)。结论 肩峰指数、关节盂倾斜度均与Constant-Murley、UCLA评分密切相关,可作为反映肩关节镜手术后功能恢复的有效指标。
Abstract:Objective To explore the relationships between acromion index,glenoid inclination and functional recovery after arthroscopic surgery.Methods From September 2016 to September 2018,50 patients who underwent shoulder arthroscopic surgery in Orthopaedic Department of Oriental Hospital of Beijing University of traditional Chinese medicine and Dongzhimen Hospital of Beijing University of traditional Chinese Medicine were selected as the study objects.There were 27 males and 23 females,with an average age of (55.70±13.04)years (range 30~75 years),including left shoulder 21 cases,right shoulder 29 cases.X-ray,magnetic resonance imaging (MRI) and electronic computed tomography (CT) were performed before and 12 months after operation;Constant-Murley score and University of California,Los Angeles (UCLA) score were used to evaluate the function of shoulder joint.And Pearson’s test was used to analyze the correlations between the imaging indexes,morphological parameters of glenoid and Constant-Murley,UCLA scores.Results At 12 months after operation,the acromion index,acromial angle,coracoacromial ligament thickness,acromioclavicular osteophyte height,glenoid height,width and inclination angle were significantly lower than those before operation (P<0.05),and the scapulohumeral space and glenoid rotation angle of shoulder joint were significantly greater than those before operation (P<0.05).The scores of Constant-Murley and UCLA at 12 months after operation were significantly higher than those before operation (P<0.05).The acromion index,acromial angle,coracoacromial ligament thickness,acromioclavicular osteophyte height,glenoid height,width and inclination angle were negatively correlated with the Constant-Murley and UCLA scores (P<0.05),and the scapulohumeral space and glenoid rotation angle of shoulder joint were positively correlated with the Constant-Murley and UCLA scores (P<0.05).Conclusion Acromion index and glenoid inclination are closely related to Constant-Murley and UCLA scores,which may be an effective index to reflect the functional recovery after arthroscopy.
[1]Dørum IH,Heir S,Solheim E,et al.Implementation of conservative treatment prior to arthroscopic subacromial decompression of the shoulder[J].Knee Surg Sports Traumatol Arthrosc,2017,25(7):2060-2066.
[2]桑鹏,刘毅,方琴.关节镜下治疗8例肩峰下米粒体滑囊炎的近期临床疗效观察[J].重庆医学,2019,48(11):1965-1968.
[3]Humphries A,Cirovic S,Shaheen AF.Shoulder bone geometry affects the active and passive axial rotational range of the glenohumeral joint[J].Am J Sports Med,2017,45(13):3010-3019.
[4]刘磊,杨宗酉,孙家元,等.2003年至2012年河北医科大学第三医院肩关节盂骨折的流行病学研究[J].中华创伤骨科杂志,2017,19(4):329-332.
[5]Nyffeler RW,Werner CM,Sukthankar A,et al.Association of a large lateral extension of the acromion with rotator cuff tears[J].J Bone Joint Surg (Am),2006,88(4):800-805.
[6]张丽华,郭龙军,米立新,等.肩峰下撞击综合征MRI评分与肩关节功能的关系[J].中国医学影像学杂志,2019,27(3):52-56.
[7]陈晓巧,刘晓玲,冯友珍,等.MRI评价肩峰形态与肩袖撕裂的关系[J].中国医学影像技术,2017,33(7):1066-1070.
[8]Werner BC,Gulotta LV,Dines JS,et al.Acromion compromise does not significantly affect clinical outcomes after reverse shoulder arthroplasty:A matched case-control study[J].HSSJ,2019,15(2):147-152.
[9]Shiota Y,Yamamoto N,Kawakami J,et al.Contact pressure of the coracoacromial arch in shoulders with joint contracture:A cadaveric study[J].J Orthop Sci,2017,22(6):1031-1041.
[10]李杰,潘昭勋,孙超,等.影像测量肩峰指数与肱骨头相对高度的相关性[J].中国矫形外科杂志,2019,27(6):566-568.
[11]冯敏,张睿锐,王涛,等.肩峰指数与退变性全层肩袖撕裂之间的相关性研究[J].中国骨与关节杂志,2019,8(3):216-219.
[12]袁丹军,唐志洋,单秀红,等.核磁共振相关定量参数与肩峰下撞击综合征的相关性研究[J].广西医科大学学报,2019,36(1):25-28.
[13]Denard PJ,Lederman E,Parsons BO,et al.Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty[J].J Orthop Res,2017,35(7):1548-1555.
[14]张振华,胡皓凡,鲁思源,等.喙突内外径及前后径与关节盂宽度的关系[J].解剖学杂志,2017,40(3):290-291.
[15]黄德刚,杨昕,贺华正,等.肩关节镜下单排简单间断缝合和单排改良Mason-Allen缝合治疗中小型肩袖损伤的效果[J].中国医药导报,2018,15(18):56-59.