中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (3): 435-439.doi: 10.12307/2022.072

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

肩胛盂扭转角与退变性肩袖全层撕裂的关系：配对病例对照试验

武亚飞1，2，朱  梁1，任秋健1，2，李大恩1，2，李大地1，2，高绪仁1，郭开今1   

  1. 1徐州医科大学附属医院骨科，江苏省徐州市   221000；2徐州医科大学，江苏省徐州市   221000
  • 收稿日期:2021-02-25 修回日期:2021-02-27 接受日期:2021-03-31 出版日期:2022-01-28 发布日期:2021-10-29
  • 通讯作者: 高绪仁，博士，博士后，主任医师，副教授，徐州医科大学附属医院，江苏省徐州市 221000 郭开今，博士，主任医师，教授，徐州医科大学附属医院，江苏省徐州市 221000
  • 作者简介:武亚飞，男，1994年生，安徽省滁州市人，汉族，徐州医科大学在读硕士，医师，主要从事骨科相关疾病治疗的研究。
  • 基金资助:
    江苏省省级重点研发专项资金(BE2015627)，项目负责人：郭开今

Relationship between glenoid version angle and degenerative rotator cuff full-thickness tear: matched case control trial

Wu Yafei1, 2, Zhu Liang1, Ren Qiujian1, 2, Li Daen1, 2, Li Dadi1, 2, Gao Xuren1, Guo Kaijin1   

  1. 1Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; 2Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Received:2021-02-25 Revised:2021-02-27 Accepted:2021-03-31 Online:2022-01-28 Published:2021-10-29
  • Contact: Gao Xuren, MD, Chief physician, Associate professor, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China Guo Kaijin, MD, Chief physician, Professor, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • About author:Wu Yafei, Master candidate, Physician, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Supported by:
    Jiangsu Provincial Key Research & Development Special Fund, No. BE2015627 (to GKJ)

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摘要：

文题释义：
肩袖撕裂：是引起肩关节疼痛和功能障碍的常见原因。肩袖由冈上肌、后方的冈下肌和小圆肌以及前方的肩胛下肌组成，对维持肩关节的稳定和功能起重要作用，治疗的目的是使得肌腱得到最大程度的愈合，若诊断或治疗不及时，常易引起冻结肩、巨大肩袖撕裂等后遗症。
肩胛盂扭转角：表示肩胛盂在横轴位上向前或向后倾斜的程度，分为向前的扭转角(即前倾)和向后的扭转角(即后倾)，角度为肩胛盂后缘切线与肩胛骨轴线的夹角减去90°的角度值，正值代表肩胛盂前倾，负值代表后倾，零值代表肩胛盂呈中立位。肩胛盂扭转角对全层肩袖撕裂、肩关节不稳、肩关节假体设计等研究具有重要的参考意义。

背景：肩袖撕裂是引起肩关节疼痛和功能障碍的常见原因，肩胛盂的形态学一直是退变性肩袖撕裂的重要研究课题。
目的：探究肩胛盂扭转角、肩胛盂前后径与退变性肩袖全层撕裂之间的关系。
方法：应用配对病例对照研究，选取2020年2月至2021年2月徐州医科大学附属医院收治经MRI及肩关节镜检测确诊为全层肩袖撕裂的患者36例为试验组，以受试对象的年龄、性别、数量为配对条件，选取同期住院的非肩关节疾病的患者36例为对照组。两组患者都在入院时做了胸部CT，并由同一名骨科医师在胸部CT上测得肩胛盂扭转角以及肩胛盂前后径，对两组之间肩胛盂扭转角度的差异性进行统计学分析。
结果与结论：①试验组肩胛盂扭转角为(-3.5±4.6)°，与对照组(-1.9±3.9)°相比，有着更加明显的后倾(P < 0.05)；②试验组肩胛盂前后径为(26.8±3.3) mm，对照组肩胛盂前后径为(27.2±3.6) mm，两组间差异无显著性意义(P > 0.05)；③将对照组肩关节进行左右分组，结果显示左侧肩胛盂扭转角为(-1.85±5.42)°，右侧肩胛盂扭转角为(-2.01±6.18)°，差异无显著性意义(P > 0.05)；④患者根据性别进行分组时，发现肩胛盂前后径在男性和女性之间差异有显著性意义(P < 0.05)；⑤提示肩胛盂大小(前后径)与肩袖的全层撕裂不存在显著相关性，但此次研究所发现的肩胛盂大小的特征性、左右肩的一致性以及男女性别之间的差异性，可以为国人肩关节假体的设计提供指导意见。肩胛盂扭转角与肩袖全层撕裂有显著相关性，肩胛盂过度后倾可能是退行性全层肩袖撕裂的危险因素，测定肩胛盂的扭转角度有助于诊断性评估肩袖全层撕裂。
https://orcid.org/0000-0003-3411-9192 (武亚飞) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 肩袖撕裂, 肩胛盂扭转角, 肩胛盂前后径, 胸部CT, 肩关节镜, 肩关节假体

Abstract: BACKGROUND: Rotator cuff tear is a common cause for shoulder pain and dysfunction. The morphology of scapular glenoid has always been an important research topic of degenerative rotator cuff tear.  
OBJECTIVE: To explore the relationship between glenoid version angle, scapular glenoid size and degenerative rotator cuff full-thickness tear.
METHODS:  In a matched case-control study, 36 patients with full-thickness rotator cuff tears diagnosed by MRI and shoulder arthroscopy in the Affiliated Hospital of Xuzhou Medical University from February 2020 to February 2021 were selected as the trial group. The 36 patients with non-shoulder diseases in the same period were selected as the control group according to the age, sex and number of the subjects. Chest CT was performed on admission in both groups. The glenoid version angle and anteroposterior diameter of scapular glenoid were measured by the same orthopedic surgeon on the chest CT, and the difference of the glenoid version angle between the two groups was statistically analyzed.  

RESULTS AND CONCLUSION: (1) The glenoid version angle: in the trial group (-3.5±4.6)°, compared with the control group (-1.9±3.9)°, there was a more obvious posterior inclination (P < 0.05). (2) In the trial group, the anteroposterior diameter of the scapular glenoid was (26.8±3.3) mm. In the control group, the anteroposterior diameter of the scapular glenoid was (27.2±3.6) mm (P > 0.05). (3) The shoulder joints of the control group were divided into left and right groups, and the results showed that the left scapular glenoid version angle was (-1.85±5.42)°, and the right scapular glenoid version angle was (-2.01±6.18)°. There was no significant difference between the two groups (P > 0.05). (4) When the patients were divided into groups according to sex, the results showed that there was a significant difference in the anteroposterior diameter of the scapular glenoid between males and females (P < 0.05). (5) It is concluded that there is no significant correlation between the size of the scapular glenoid (anteroposterior diameter) and the full-thickness tear of the rotator cuff, but results found the size characteristics of the scapular glenoid, the consistency of the left and right shoulders, and the significant differences between men and women. It is believed that it can provide guidance for the design of shoulder prosthesis in Chinese. There is a significant correlation between the glenoid version angle and the full-thickness rotator cuff tear. Excessive retroversion of the scapular glenoid may be a risk factor for degenerative full-thickness rotator cuff tear. Measuring the glenoid version angle is helpful for the diagnostic evaluation of full-thickness rotator cuff tear.

Key words: rotator cuff tear, glenoid version angle, anteroposterior diameter, chest CT, should arthroscopes, shoulder prosthesis

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