肩袖损伤程度和肱骨头上移距离间的相关性分析

doi:10.19723/j.issn.1671-167X.2019.02.014

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (2): 273-276. doi: 10.19723/j.issn.1671-167X.2019.02.014

肩袖损伤程度和肱骨头上移距离间的相关性分析

张一翀,陈建海,党育,杨明,付中国,张殿英,张培训(),姜保国()

北京大学人民医院创伤骨科,北京大学创伤医学中心,北京 100044

收稿日期:2017-04-19 出版日期:2019-04-18 发布日期:2019-04-26
通讯作者: 张培训,姜保国 E-mail:zhangpeixun@126.com;jiangbaoguo@vip.sina.com
基金资助:
国家重点基础研究发展计划(973计划)(2014CB542201);国家高技术研究发展计划(863计划)(SS2015AA020501);国家自然科学基金(31571235);国家自然科学基金(31571236);国家自然科学基金(31271284);国家自然科学基金(31171150)

Correlation analysis between rotator cuff tear and the superior migration of humeral head

Yi-chong ZHANG,Jian-hai CHEN,Yu DANG,Ming YANG,Zhong-guo FU,Dian-ying ZHANG,Pei-xun ZHANG(),Bao-guo JIANG()

Department of Trauma and Orthopaedics, Peking University People’s Hospital, Peking University Trauma Medicine Center, Beijing 100044, China

Received:2017-04-19 Online:2019-04-18 Published:2019-04-26
Contact: Pei-xun ZHANG,Bao-guo JIANG E-mail:zhangpeixun@126.com;jiangbaoguo@vip.sina.com
Supported by:
the National Basic Research Program of China(973 Program)(2014CB542201);the National High Technology Research and Development Program of China(863 Program)(SS2015AA020501);the National Natural Science Foundation of China(31571235);the National Natural Science Foundation of China(31571236);the National Natural Science Foundation of China(31271284);the National Natural Science Foundation of China(31171150)

摘要/Abstract

摘要：

目的: 评估肩袖组织损伤程度与肱骨头上移距离之间的关系。方法: 选取2015年9月至2016年5月北京大学人民医院创伤骨科收治的肩袖损伤患者30例,均已行患侧肩关节磁共振及X线检查。将患者根据X线正位片测量所得的肱骨头上移系数(upward migration index,UMI),即肱骨头中心至肩峰距离与肱骨头半径的比值分为3个小组,每组10人,组1:1.2≥UMI >1,组2:1.4≥UMI >1.2,组3:UMI >1.4,进行Spearman等级相关分析,判定不同的UMI值与肩袖组织脂肪变程度、肩袖撕裂范围、撕裂处冈上肌厚度之间的关系。结果: 在X线正位片上,平均UMI值为1.33(范围1.02~1.51,标准差为±0.22),UMI值与肩袖组织撕裂的大小呈负相关(R=-0.584,P<0.01),与冈上肌脂肪变程度呈负相关(R=-0.312,P=0.033),而与磁共振上撕裂处冈上肌厚度并无相关性(R=0.127,P=0.071)。结论: UMI与肩袖撕裂及肩袖脂肪变程度存在相关性,UMI值与肩袖组织撕裂大小和冈上肌脂肪化程度呈负相关,其数值减小是肩袖撕裂及脂肪化退变的可靠标志。当患者因急性肩痛就诊时,门诊医师可结合临床表现、体格检查及X线影像学检查结果作出初步判断,对初步筛查肩袖损伤及指导进一步治疗具有重要意义。

关键词: 肩袖损伤, 肱骨, 肩关节, 肩痛, 腱损伤, 诊断显像

Abstract:

Objective: To evaluate the association between rotator cuff tear and the proximal migration of humeral head.Methods: In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People’s Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups , and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.Results: In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).Conclusion: UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.

Key words: Rotator cuff injuries, Humerus, Shoulder joint, Shoulder pain, Tendon injuries, Diagnostic imaging

中图分类号:

R681.7

张一翀,陈建海,党育,杨明,付中国,张殿英,张培训,姜保国. 肩袖损伤程度和肱骨头上移距离间的相关性分析[J]. 北京大学学报（医学版）, 2019, 51(2): 273-276.

Yi-chong ZHANG,Jian-hai CHEN,Yu DANG,Ming YANG,Zhong-guo FU,Dian-ying ZHANG,Pei-xun ZHANG,Bao-guo JIANG. Correlation analysis between rotator cuff tear and the superior migration of humeral head[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 273-276.

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参考文献 17

[1]	Nové-josserand L, Edwards TB, O’Connor DP , et al. The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration[J]. Clin Orthop Relat Res, 2005,433:90-96.
[2]	Bezer M, Yildirim Y, Akgün U , et al. Superior excursion of the humeral head: a diagnostic tool in rotator cuff tear surgery[J]. J Shoulder Elbow Surg, 2005,14(4):375-379. doi: 10.1016/j.jse.2004.12.001
[3]	Ellman H, Hanker G, Bayer M . Repair of the rotator cuff. End-result study of factors influencing reconstruction[J]. J Bone Joint Surg Am, 1986,68(8):1136-1144. doi: 10.2106/00004623-198668080-00002
[4]	Norwood LA, Barrack R, Jacobson KE . Clinical presentation of complete tears of the rotator cuff[J]. J Bone Joint Surg Am, 1989,71(4):499-505. doi: 10.2106/00004623-198971040-00004
[5]	Ottenheijm RPG, Cals JWL, Winkens B , et al. Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice[J]. BMJ Open, 2016,6(11):e011048. doi: 10.1136/bmjopen-2016-011048
[6]	Nové-Josserand L, Levigne C, Noel E , et al. The acromio-hume-ral interval. A study of the factors influencing its height[J]. Rev Chir Orthop Reparatrice Appar Mot, 1996,82(5):379-385.
[7]	Mccreesh KM, Crotty JM, Lewis JS . Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review[J]. Br J Sports Med, 2015,49(5):298-305. doi: 10.1136/bjsports-2012-092063
[8]	van de Sande MAJ, Rozing PM . Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs[J]. Clin Orthop Relat Res, 2006,443:260-265. doi: 10.1097/01.blo.0000196043.34789.73
[9]	Goutallier D, Postel JM, Bernageau J , et al. Fatty muscle dege-neration in cuff ruptures. Pre- and postoperative evaluation by CT scan[J]. Clin Orthop Relat Res, 1994,304:78-83.
[10]	Fuchs B, Weishaupt D, Zanetti M , et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging[J]. J Shoulder Elbow Surg, 1999,8(6):599-605. doi: 10.1016/S1058-2746(99)90097-6
[11]	Weiner DS, Macnab I . Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff[J]. J Bone Joint Surg Br, 1970,52(3):524-527.
[12]	Mall NA, Kim HM, Keener JD , et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables[J]. J Bone Joint Surg Am, 2010,92(16):2623-2633. doi: 10.2106/JBJS.I.00506
[13]	Cotty P, Proust F, Bertrand P , et al. Rupture of the rotator cuff. Quantification of indirect signs in standard radiology and the Leclercq maneuver[J]. J Radiol, 1988,69(11):633-638.
[14]	Teefey SA, Rubin DA, Middleton WD , et al. Detection and quantification of rotator cuff tears[J]. J Bone Joint Surg Am, 2004,86(4):708-716. doi: 10.2106/00004623-200404000-00007
[15]	Duncan NS, Booker SJ, Gooding BW , et al. Surgery within 6 months of an acute rotator cuff tear significantly improves outcome[J]. J Shoulder Elbow Surg, 2015,24(12):1876-1880. doi: 10.1016/j.jse.2015.05.043
[16]	Goutallier D, Guilloux PL, Postel JM , et al. Acromio humeral distance less than six millimeter: Its meaning in full-thickness rotator cuff tear[J]. Orthop Traumatol Surg Res, 2011,97(3):246-251. doi: 10.1016/j.otsr.2011.01.010
[17]	Lapner PC, Su Y, Simon D , et al. Does the upward migration index predict function and quality of life in arthroscopic rotator cuff repair?[J]. Clin Orthop Relat Res, 2010,468(11):3063-3069. doi: 10.1007/s11999-010-1457-7

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UMI	Full-thickness tear of supraspinatus	Jobe test positive
1<UMI≤1.2 (n=10)	7 (70%)	8 (80%)
1.2<UMI≤1.4 (n=10)	3 (30%)	8 (80%)
UMI>1.4 (n=10)	2 (20%)	7 (70%)

UMI	Fatty degeneration (Goutallier classification)
UMI	0	1	2	3	4
1<UMI≤1.2 (n=10)	2	3	4	0	1
1.2<UMI≤1.4 (n=10)	5	2	2	1	0
UMI>1.4 (n=10)	6	2	2	0	0

Items	UMI	Tear size	Fatty degeneration	Thickness of supraspinatus
Correlation coefficent	1.000	-0.584^a	-0.312^b	0.127
Significance level (bilateral)	-	<0.01	0.033	0.071

肩袖损伤程度和肱骨头上移距离间的相关性分析

Correlation analysis between rotator cuff tear and the superior migration of humeral head

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