目的 探讨肩胛骨影像解剖学特点与非创伤性肩袖撕裂的相关性。 方法 回顾性分析经手术证实的非创伤性肩袖撕裂患者50例以及正常成人48例的肩关节正位和“Y”位X线片，测量其外侧肩峰角、临界肩角、肩峰指数、关节盂倾斜度，观察尖锐肩峰、肩峰形态、肩锁关节骨赘及肩峰下骨质硬化等肩胛骨相关解剖学特点，比较两组影像解剖学参数差异，采用logistic回归分析筛选非创伤性肩袖撕裂的独立影响因素，利用受试者工作特征（ROC）曲线分析独立影响因素对非创伤性肩袖撕裂的诊断效能。 结果 两组年龄、性别、侧别、身高体重指数、是否体力劳动者、肩峰形态及肩锁关节骨赘比较无统计学差异（P>0.05）；外侧肩峰角、临界肩角、肩峰指数、关节盂倾斜度、尖锐肩峰及肩峰下骨质硬化比较具有统计学差异（P<0.05），肩袖撕裂组外侧肩峰角低于对照组，而临界肩角、肩峰指数、关节盂倾斜度、尖锐肩峰及肩峰下骨质硬化均高于对照组。外侧肩峰角为非创伤肩袖撕裂的保护性因素，肩峰指数、关节盂倾斜度为独立危险因素。外侧肩峰角ROC曲线下面积为0.793，灵敏度62.5%，特异度90.0%；肩峰指数ROC曲线下面积为0.749，灵敏度78.0%，特异度60.4%；关节盂倾斜度ROC曲线下面积为0.756，灵敏度72.0%，特异度77.1%；三者联合诊断的ROC曲线下面积为0.897，灵敏度89.6%，特异度76.0%。 结论 外侧肩峰角、临界肩角、肩峰指数、关节盂倾斜度、尖锐肩峰及肩峰下皮质硬化与非创伤性肩袖撕裂相关，外侧肩峰角为非创伤肩袖撕裂的保护性因素，肩峰指数、关节盂倾斜度为其独立危险因素。
Abstract
Objective To explore the correlation between radiological anatomical factors of scapula and non-traumatic rotator cuff tear. Methods The shoulder joint anteroposterior and "Y" position X-ray films of 50 patients confirmed by surgery with non-traumatic rotator cuff tear and 48 normal adults were retrospectively analyzed. Lateral acromion angle, critical shoulder angle, acromion index, and glenoid inclination of two groups were measured. And sharpened lateral acromion morphology, acromion morphology, acromioclavicular joint osteophyte, subacromial bone sclerosis were observed. The statistical differences between imaging anatomical parameters of two groups were compared. Logistic regression was used to analyze independent influencing factors for non-traumatic rotator cuff tears. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of independent influencing factors for non-traumatic rotator cuff tear. Results There were no statistical differences in age, gender, side, body mass index (BMI), manual worker, acromion morphology, and acromioclavicular joint osteophyte between two groups (P>0.05). However, there were statistical differences in lateral acromion angle, critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis (P<0.05). The lateral acromion angle of the rotator cuff tear group was lower than that of control group, while critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis were higher than those of control group. Lateral acromial angle was a protective factor for non-traumatic rotator cuff tear, while the acromion index and glenoid inclination were independent risk factors. The area under ROC curve of lateral acromial angle was 0.793, with sensitivity of 62.5% and specificity of 90.0%. The area under ROC curve of acromion index was 0.749, with sensitivity of 78.0% and specificity of 60.4%. The area under ROC curve of glenoid inclination was 0.756, with sensitivity of 72.0% and specificity of 77.1%. The area under ROC curve of combined diagnosis was 0.897, with sensitivity of 89.6% and specificity of 76.0%. Conclusions Lateral acromion angle, critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis are correlated with non-traumatic rotator cuff tear. Lateral acromial angle is a protective factor for non-traumatic rotator cuff tear, while the acromion index and glenoid inclination are independent risk factors.
关键词
肩胛骨； /
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非创伤性肩袖撕裂； /
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影像解剖学； /
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相关性分析
Key words
Scapula; /
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Non-traumatic rotator cuff tear; /
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Radiologic anatomy; /
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Correlation analysis
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基金
河北省医学科学研究课题计划（20251497）
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