切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (02) : 148 -153. doi: 10.3877/cma.j.issn.2095-5790.2021.02.008

所属专题: 文献

论著

肩关节运动损伤门诊疾病谱分析
李韬1, 牟可凡1, 熊燕1, 李棋1, 陈刚1, 付维力1, 李箭1, 唐新1,()   
  1. 1. 610041 成都,四川大学华西医院骨科
  • 收稿日期:2020-10-10 出版日期:2021-05-05
  • 通信作者: 唐新
  • 基金资助:
    四川省科技支撑重大项目(2017S20017、2018SZ0237)

Outpatient spectrum analysis of shoulder joint sports injury

Tao Li1, Kefan Mou1, Yan Xiong1, Qi Li1, Gang Chen1, Weili Fu1, Jian Li1, Xin Tang1,()   

  1. 1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2020-10-10 Published:2021-05-05
  • Corresponding author: Xin Tang
引用本文:

李韬, 牟可凡, 熊燕, 李棋, 陈刚, 付维力, 李箭, 唐新. 肩关节运动损伤门诊疾病谱分析[J/OL]. 中华肩肘外科电子杂志, 2021, 09(02): 148-153.

Tao Li, Kefan Mou, Yan Xiong, Qi Li, Gang Chen, Weili Fu, Jian Li, Xin Tang. Outpatient spectrum analysis of shoulder joint sports injury[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(02): 148-153.

目的

统计近5年本院门诊肩关节运动医学疾病的疾病谱,分析其潜在影响因素,从而为临床诊治提供参考。

方法

收集本院自2014年1月至2018年12月运动医疗团队中所有肩部门诊及病房服务患者相关信息数据,共计纳入患者1 708例。其中同一患者以最终门诊的诊断或手术确诊的主要诊断为准,剔除复查诊断与其他关节的相关数据。采用Excel及SPSS 22.0软件对收集所得资料进行统计分析。

结果

所有患者均由运动医疗团队进行诊断。在纳入的1 708例肩部患者中,平均年龄(50.34±13.76)岁,其中女性占57.55%。纳入患者中肩袖损伤发生率最高,为45.78%;其次为冻结肩(20.67%)和复发性脱位(8.08%);再次为SLAP/肱二头肌腱炎(5.15%)。在所有患者中初次诊断欠准确共计63例,其中最常见的被误诊疾病为冻结肩和肩袖损伤,误诊例数分别为26例(41.27%)和21例(33.33%)。

结论

肩关节疾病已成为日常生活中较为常见的疾病,其中肩袖损伤和冻结肩最为常见;国人的肩痛流行病学可能与国外有明显的差异,如冻结肩比例远远高于西方发达国家人群。但是该结论尚需要大量的多中心流行病学统计分析进行验证。

Background

As one of the most vulnerable parts of human body, shoulder joint disease is the third common musculoskeletal system disease after knee and back-related diseases. With the improvement of quality of life, people pay more attention to shoulder diseases, including frozen shoulder, rotator cuff injury, subacromial impingement syndrome, etc. However, there are few epidemiological studies on shoulder joint diseases in China.

Objective

The disease spectrum of shoulder joint sports medicine diseases in outpatient department of our hospital in recent 5 years was collected and its potential influencing factors were analyzed to provide a reference for clinical diagnosis and treatment.

Methods

From January 2014 to December 2018, a total of 1 708 patients with shoulder joint diseases in the out-patient and in-patient wards of West China Hospital were selected as the research subjects. The ultimate diagnosis of the same patient should be based on outpatient diagnosis or surgical diagnosis. Outpatient review and data related to other joints were excluded. Microsoft Excel and SPSS 22.0 softwares were used for statistical analysis of the collected data.

Results

All patients were diagnosed by the shoulder team of sports medicine. In the included 1 708 shoulder patients, the average age was (50.34±13.76) years, of which women accounted for 57.55%. Among the included patients, the incidence of rotator cuff injury was higher (45.78%) than frozen shoulder (20.67%) , recurrent dislocation (8.08%) and SLAP/biceps tendonitis (5.15%) . In all patients, the initial diagnosis was inaccurate in 63 cases, of which the most common misdiagnosed diseases were frozen shoulder (26/63, 41.27%) and rotator cuff injury (21/63, 33.33%) .

Conclusion

Shoulder joint disease has become a common disease in our daily life, among which rotator cuff injury and frozen shoulder are the most common. The epidemiology of shoulder pain in Chinese may be significantly different from that in foreign countries. For example, the proportion of frozen shoulder is much higher than that in western developed countries. However, it still needs to be verified by a large number of multicentre epidemiological statistical analysis.

表1 常见肩关节损伤类型的年龄、性别、部位的分布特点
类别 例数 性别[例(%)] 年龄(岁,±s 部位[例(%)]
总体 双侧
肩袖损伤 782 304(38.87) 478(61.13) 53.32±14.13 57.23±14.13 55.71±14.16 266(34.02) 504(64.45) 12(1.53)
冻结肩 353 121(34.28) 232(65.72) 51.58±14.10 51.92±14.11 51.80±14.11 177(50.14) 161(45.61) 15(4.25)
复发性脱位 138 112(81.16) 26(18.84) 27.80±14.12 39.30±14.20 29.97±14.12 48(34.78) 89(64.49) 1(0.72)
SLAP损伤/肱二头长头肌腱炎 88 62(73.49) 26(26.51) 35.21±12.25 40.14±13.62 36.63±12.73 31(36.14) 53(59.04) 4(4.82)
颈肩背筋膜炎 48 18(37.50) 30(62.50) 38.72±14.84 38.17±12.58 38.38±12.94 24(50) 19(39.58) 5(10.42)
肩峰下撞击综合征 47 30(63.83) 17(27.17) 42.57±13.78 49.18±5.20 44.96±11.88 8(17.02) 39(82.98) 0(0)
钙化性肌腱炎 43 3(6.98) 40(93.02) 66.67±14.34 53.63±10.40 54.53±14.11 12(27.91) 30(69.77) 1(2.12)
肩峰下滑囊炎 41 20(48.78) 21(51.22) 48.99±14.17 43.43±14.10 41.41±14.10 21(51.22) 19(46.34) 1(2.44)
骨关节炎 15 3(20) 12(80) 49±4.50 60.08±16.38 57.93±15.40 5(33.33) 10(66.67) 0(0)
肩锁关节炎 10 5(50) 5(50) 46±5.97 52.6±5.46 49.3±6.60 2(20) 7(70) 1(10)
肩袖肌腱病 4 3(75) 1(25) 55±3.74 64±0 57.25±5.07 2(50) 2(50) 0(0)
其他 139 44(31.65) 95(68.35) 52.33±13.07 49.92±6.21 50.68±8.92 62(44.60) 74(53.24) 3(2.16)
总体 1 708 725(42.46) 983(57.55) 46.54±15.76 53.14±11.29 50.34±13.76 658(38.20) 1 007(59.52) 43(2.28)
检验值   x2=170.428 t=12.028   x2=82.441  
P   <0.001 <0.001   <0.001  
图1 常见肩关节损伤类型的总体比例分布图
图2 初次诊断欠准确例数分布图
[1]
Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review [J]. Scand J Rheumatol, 2004, 33(2): 73-81.
[2]
Friedman MV, Hillen TJ, Holland DV, et al. Impact of Shoulder Sonography on Clinical Decision Making [J]. J Ultrasound Med, 2017, 36(7): 1365-1371.
[3]
Markel J, Schwarting T, Malcherczyk D, et al. Concomitant glenohumeral pathologies in high-grade acromioclavicular separation (type III - V) [J]. BMC Musculoskelet Disord, 2017, 18(1): 439.
[4]
Asker M, Holm LW, Kallberg H, et al. Female adolescent elite handball players are more susceptible to shoulder problems than their male Counterparts [J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 1892-1900.
[5]
Craig R, Holt T, Rees JL. Acute rotator cuff tears [J]. BMJ, 2017, 359:j5366.
[6]
Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States [J]. J Bone Joint Surg Am, 2010, 92(3): 542-549.
[7]
Shields DW, Jefferies JG, Brooksbank AJ, et al. Epidemiology of glenohumeral dislocation and subsequent instability in an urban population [J]. J Shoulder Elbow Surg, 2018, 27(2): 189-195.
[8]
Summitt RJ, Cotton RA, Kays AC, et al. Shoulder Injuries in Individuals Who Participate in CrossFit Training [J]. Sports Health, 2016, 8(6): 541-546.
[9]
Owens BD, Duffey ML, Nelson BJ, et al. The incidence and characteristics of shoulder instability at the United States Military Academy [J]. Am J Sports Med, 2007, 35(7): 1168-1173.
[10]
Hams A, Evans K, Adams R, et al. Epidemiology of shoulder injury in sub-elite level water polo players [J]. Phys Ther Sport, 2019, 35:127-132.
[11]
Saper MG, Pierpoint LA, Liu W, et al. Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015 [J]. Am J Sports Med, 2018, 46(1): 37-43.
[12]
Hart E, Meehan WP 3rd, Bae DS, et al. The Young Injured Gymnast: A Literature Review and Discussion [J]. Curr Sports Med Rep, 2018, 17(11): 366-375.
[13]
Robinson CM, Seah KT, Chee YH, et al. Frozen shoulder [J]. J Bone Joint Surg Br, 2012, 94(1): 1-9.
[14]
Lubowitz JH, Provencher MT, Poehling GG. ISAKOS upper extremity committee shoulder rotator cuff consensus, plus chondrocyte implantation and ACL systematic reviews [J]. Arthroscopy, 2013, 29(11): 1733-1734.
[15]
Itoi E, Arce G, Bain GI, et al. Shoulder Stiffness: Current Concepts and Concerns [J]. Arthroscopy, 2016, 32(7): 1402-1414.
[16]
Bahk M, Keyurapan E, Tasaki A, et al. Laxity testing of the shoulder: a review [J]. Am J Sports Med, 2007, 35(1): 131-144.
[17]
Provencher MT, Leclere LE, King S, et al. Posterior instability of the shoulder: diagnosis and management [J]. Am J Sports Med, 2011, 39(4): 874-886.
[18]
Bartoszewski N, Parnes N. Rotator cuff injuries [J]. Jaapa, 2018, 31(4): 49-50.
[19]
Forthomme B, Croisier JL, Delvaux F, et al. Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players [J]. J Athl Train, 2018, 53(2): 174-180.
[20]
Bjarnison AO, Sorensen TJ, Kallemose T, et al. The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study [J]. J Shoulder Elbow Surg, 2017, 26(12): 2097-2102.
[21]
Braune C, Von Eisenhart-Rothe R, Welsch F, et al. Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears [J]. Arch Orthop Trauma Surg, 2003, 123(8): 419-424.
[22]
Katzer A, Wening JV, Becker-Mannich HU, et al. Rotator cuff rupture. Vascular supply and collagen fiber processes as pathogenetic factors [J]. Unfallchirurgie, 1997, 23(2): 52-59.
[23]
Gumina S, Arceri V, Carbone S, et al. The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes [J]. J Shoulder Elbow Surg, 2013, 22(2): 229-232.
[24]
Teratani T. Comparison of the epidemiology and outcomes of traumatic and nontraumatic rotator cuff tears [J]. J Orthop, 2017, 14(1): 166-170.
[25]
Lin KM, James EW, Spitzer E, et al. Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators [J]. Curr Opin Pediatr, 2018, 30(1): 49-56.
[26]
Leroux T, Ogilvie-harris D, Veillette C, et al. The epidemiology of primary anterior shoulder dislocations in patients aged 10 to 16 years [J]. Am J Sports Med, 2015, 43(9): 2111-2117.
[27]
Wright V, Haq AM. Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors [J]. Ann Rheum Dis, 1976, 35(3): 213-219.
[28]
Alsubheen SA, Nazari G, Bobos P, et al. Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review [J]. Arch Phys Med Rehabil, 2019, 100(2): 350-365.
[29]
Huang YP, Fann CY, Chiu YH, et al. Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: a longitudinal population-based followup study [J]. Arthritis Care Res (Hoboken), 2013, 65(7): 1197-1202.
[30]
Hadzic V, Sattler T, Veselko M, et al. Strength asymmetry of the shoulders in elite volleyball players [J]. J Athl Train, 2014, 49(3): 338-344.
[1] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2] 李程, 朱梁, 庞勇, 查国春, 仇尚, 孙伟, 冯硕. 侧侧缝合联合无结缝线桥技术治疗大型L型肩袖撕裂[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 301-306.
[3] 王旭, 钱航, 刘军, 时志斌, 党晓谦, 刘瑞宇. 肱骨近端骨折合并肩袖损伤对半肩关节置换术后的影响[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 8-16.
[4] 张琛朋, 王靖, 曾塬杰, 高鹏, 陈昕彤. 反式全肩关节置换术的研究进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 373-376.
[5] 陈天鑫, 杨胜平, 朱瑜琪, 高云, 张帅. 多种手术方式治疗肩关节前向不稳定伴关节盂骨缺损的网状Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 344-352.
[6] 王友健, 陶然, 陆跃, 马洪冬. 退行性中、小型肩袖撕裂两种临床治疗效果对比[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 302-308.
[7] 曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[8] 马明太, 居家宝, 张一翀, 丁镇涛, 张殿英, 付中国, 陈建海. 肱骨大结节骨折的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 277-280.
[9] 白正林, 高明, 孟增东. 肩关节置换术后假体周围感染的研究进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 271-276.
[10] 王涵宇, 王蕾. Bankart损伤的关节镜下修复进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 262-270.
[11] 赵静磊, 陈晓婷, 夏莹, 黄维佳, 周菊, 刘芳. 锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素研究[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 216-222.
[12] 单磊, 周君琳. 同期修复肩袖撕裂结合锁定钢板治疗老年肱骨近端骨折的特点及疗效分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 211-215.
[13] 吴念儒, 王蕾. 反式肩关节置换治疗巨大肩袖损伤与其手术进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(02): 177-183.
[14] 李丹妹, 许鉴. 基于CT三维重建技术的正常关节盂宽度和高度关系及形态学研究[J/OL]. 中华肩肘外科电子杂志, 2024, 12(01): 69-74.
[15] 乐佳迪, 蔡乐益, 陈思源, 鲁建鹏, 陈龙. 肱骨近端骨折经微创钢板接骨术治疗术后的放射学测量与肩关节功能关系[J/OL]. 中华肩肘外科电子杂志, 2024, 12(01): 61-68.
阅读次数
全文


摘要