较大的肱骨大结节角和峰盂角与肩袖撕裂的相关性

doi:10.19723/j.issn.1671-167X.2025.04.018

摘要/Abstract

摘要：

目的: 肱骨大结节角(greater tuberosity angle，GTA)和峰盂角(critical shoulder angle，CSA)通常作为影像学标记用于描述肱骨大结节和肩峰的形态，本研究分析肩袖撕裂患者GTA和CSA的变化趋势和风险阈值，并探讨肩袖撕裂的保护因素和危险因素。方法: 从2019年5月至2020年12月共回顾性纳入130例患者，根据南加州骨科研究所(Southern California Orthopaedic Institute，SCOI)的分类法，将患者分为4组：A组，正常对照组；B组，部分肩袖撕裂(关节侧)组；C组，部分肩袖撕裂(滑囊侧)组；D组，全层肩袖撕裂组。在单盲条件下，由同一组医生分别在手臂中立位的肩胛骨正位X线片上测量GTA和CSA，分析其对肩袖撕裂的诊断价值，同时对可能影响肩袖撕裂的因素进行相关性分析。结果: 根据受试者工作特征(receiver operating characteristic，ROC)曲线下面积(area under curve，AUC)，在95%置信区间(confidence interval，CI)内，肩袖撕裂组(B、C、D组)的GTA和CSA分别为0.736和0.673，肩袖撕裂患者的GTA和CSA临界值(cut-off value)分别为70.5°和39.5°。与对照组相比，各肩袖撕裂组在身高、年龄、体重指数(body mass index，BMI)等方面差异均有统计学意义(P < 0.05)，全层肩袖撕裂组(D组)患者的年龄更大(P < 0.05，临界值为56.5岁)，比A、B组身高更低(P < 0.05，临界值为1.58 m)。散点图和回归分析显示，GTA与CSA之间不存在线性相关。与对照组相比，肩袖撕裂组在性别、优势肩和吸烟等方面差异无统计学意义(P>0.05)。结论: 较大的GTA(>70.5°)和CSA(>39.5°)可能对诊断肩袖撕裂具有较高的预测价值，相较而言，GTA的诊断价值更高；年龄>56.5岁、身高 < 1.58 m的患者更易发生全层肩袖撕裂；性别、优势肩、吸烟既不是危险因素，也不是保护因素。

关键词: 肩袖撕裂, 肱骨大结节角, 峰盂角, 肩撞击综合征

Abstract:

Objective: The greater tuberosity angle (GTA) and critical shoulder angle (CSA) are commonly referred to as radiographic markers which were used to described morphology of the greater tuberosity and acromion respectively. At present, most international studies focus on the correlation between the above two parameters and rotator cuff tears (RCTs), and their diagnostic value and risk assessment. This study attempts to find out the trend of GTA and CSA changes and risk threshold of RCTs, as well as the protective factors and risk factors. Methods: In this study, 130 individuals from May 2019 to December 2020 were recruited. According to Southern California Orthopedic Institute (SCOI) classification, the individuals were divided into four groups retrospectively: Group A, negative control group; Group B, partial tears (articular side); Group C, partial tears (bursal side); Group D, full-thickness tears. GTA and CSA were measured respectively on true anteroposterior position X-ray of shoulder with arm in neutral rotation and performed by the same trained technician team in single-blind. The correlations between RCTs and relevant factors were analyzed. Results: According to the area under the receiver operating characteristic curve (AUC), GTA and CSA of RCTs (Groups B, C and D) were 0.736 and 0.673 with 95% confidence interval (CI), the cut-off value of GTA and CSA of RCTs were 70.5° and 39.5° respectively. Comparing with the control group, RCTs groups had significant statistical differences in age and body mass index (BMI) (P < 0.05), especially the full-thickness RCTs (Group D), which was older than Groups A, B and C (P < 0.05, cut-off value: 56.5 years old) and shorter than Groups A and B (P < 0.05, cut-off value: 1.58 m). Analyzed from scatter plot and regression analysis, there was no linear correlation between GTA and CSA. There were no significant differences in gender, dominant shoulders and smoking between the RCTs groups and the control group (P>0.05). Conclusion: Larger GTA (>70.5°) and CSA (>39.5°) would be highly predictive in diagnosing RCTs without linear correlation, and GTA has a higher diagnostic value in contrast. Subacromial impingement and shoulder degeneration occurred before RCTs. Patients with age >56.5 years and height < 1.58 m were more likely to develop disease of full-thickness RCTs and no statistic differences in weight and BMI. Gender, dominant shoulder and smoking were neither risk factors nor protective factors.

Key words: Rotator cuff tears, Greater tuberosity angle, Critical shoulder angle, Shoulder impingement syndrome

中图分类号:

R684

蒋华, 颜宇, 李盼盼, 陈康, 马红兵, 曾勇, 唐新, 崔国庆. 较大的肱骨大结节角和峰盂角与肩袖撕裂的相关性[J]. 北京大学学报（医学版）, 2025, 57(4): 740-747.

Hua JIANG, Yu YAN, Panpan LI, Kang CHEN, Hongbing MA, Yong ZENG, Xin TANG, Guoqing CUI. Association of increased greater tubercle angle and critical shoulder angle with rotator cuff tears[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 740-747.

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Measurements	ICC-1	ICC-2	ICC-3
CSA	0.988	0.988	0.897
GTA	0.977	0.990	0.921

Items	Group A	Group B	Group C	Group D	P value
Age/years, ${\bar x}$±s	27.76±7.30	54.00±14.89	51.27±8.41	64.24±10.01	＜0.001
Weight/kg, ${\bar x}$±s	58.90±6.51	63.83±9.06	63.27±6.13	61.43±10.06	0.075
Height/m, ${\bar x}$±s	1.64±0.50	1.65±0.78	1.62±0.68	1.59±0.07	0.001
BMI/(kg/m²), ${\bar x}$±s	21.82±1.73	23.24±1.91	24.04±1.54	24.10±2.93	＜0.001
Gender (male/female), n	16/26	8/16	10/12	7/35	0.067
Shoulder (left/right), n	16/26	8/16	12/10	18/24	0.487
Smoking (yes/no), n	6/36	2/22	2/20	2/40	0.511

Items	Group A	Group B	Group C	Group D
CSA, ${\bar x}$±s	35.33±4.69	38.56±4.83	40.23±5.72	39.18±7.18
GTA, ${\bar x}$±s	68.36±3.06	70.54±3.08	71.09±5.31	72.62±5.37

Items	Group A	Group B	Group C	Group D
Group A	-	0.028^*	0.001^**	0.002^**
Group B	0.028^*	-	0.323	0.673
Group C	0.001^**	0.323	-	0.485
Group D	0.002^**	0.673	0.485	-

Items	Group A	Group B	Group C	Group D
Group A	-	0.045^*	0.015^*	＜0.001^**
Group B	0.045	-	0.660	0.057
Group C	0.015^*	0.660	-	0.172
Group D	＜0.001^**	0.057	0.172	-