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中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 229 -235. doi: 10.3877/cma.j.issn.2095-5790.2021.03.007

论著

基于CT三维模型分析肩胛下肌腱损伤患者喙突形态和位置的研究
马秉贤1, 张永2, 包呼日查1, 周慧文1, 魏宝刚1, 王永祥1, 齐岩松1,(), 徐永胜1,()   
  1. 1. 010017 呼和浩特,内蒙古自治区人民医院骨关节科(运动医学中心)
    2. 010020 呼和浩特,内蒙古自治区国际蒙医医院急诊与重症医学科
  • 收稿日期:2020-06-16 出版日期:2021-09-13
  • 通信作者: 齐岩松, 徐永胜
  • 基金资助:
    内蒙古自治区人民医院院内基金项目(201810, 201501); 内蒙古自治区科技计划项目(201602098)

Study on morphology and position of coracoid process in patients with subscapular tendon tear based on CT three-dimensional model

Bingxian Ma1, Yong Zhang2, Huricha Bao1, Huiwen Zhou1, Baogang Wei1, Yongxiang Wang1, Yansong Qi1,(), Yongsheng Xu1,()   

  1. 1. Department of Orthopedics (Sports Medicine Center) , Inner Mongolia People's Hospital, Hohhot 010017, China
    2. Department of Emergency and Critical Care, Inner Mongolia International Mongolian Hospital, Hohhot 010010, China
  • Received:2020-06-16 Published:2021-09-13
  • Corresponding author: Yansong Qi, Yongsheng Xu
引用本文:

马秉贤, 张永, 包呼日查, 周慧文, 魏宝刚, 王永祥, 齐岩松, 徐永胜. 基于CT三维模型分析肩胛下肌腱损伤患者喙突形态和位置的研究[J]. 中华肩肘外科电子杂志, 2021, 09(03): 229-235.

Bingxian Ma, Yong Zhang, Huricha Bao, Huiwen Zhou, Baogang Wei, Yongxiang Wang, Yansong Qi, Yongsheng Xu. Study on morphology and position of coracoid process in patients with subscapular tendon tear based on CT three-dimensional model[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(03): 229-235.

目的

基于CT三维模型分析测量喙突形态和位置,探究其与肩胛下肌腱损伤(subscapularis tendon tears, STT)的相关性。

方法

回顾性收集了退行性肩袖损伤关节镜术后患者和健康人肩关节影像学(CT)数据,分为肩袖损伤伴STT组(A组,28例)和不伴STT组(B组,26例),以及健康组(C组,22例)。采用Mimics软件对肩胛骨进行三维建模并对喙突及关节盂位置进行评估,测量喙突长度(length of coracoid,LC)、喙突前后间距(anteroposterior distance of coracoid,ADC)、喙突高度(height of coracoid,HC)、关节盂平面扭转角(version angle of glenoid,VAG)和关节盂平面倾斜角(inclination angle of glenoid,IAG),分析比较各组参数。

结果

测量结果显示,LC在A、B、C三组中分别为(21.32±3.83)mm、(18.95±2.36)mm和(17.75±2.69)mm;ADC分别为(23.52±4.04)mm、(22.83±2.37)mm和(24.03±3.65)mm;HC分别为(20.76±3.35)mm、(23.33±2.7)mm和(22.86±3.64)mm;VAG分别为(-2.99±3.27)°、(-2.28±4.9)°和(-2.83±4.4)°;IAG分别为107.82°(101.59-112.04)°、110.19°(105.86-118.72)°和110.37°(104.9-118.02)°。A、B两组间比较:LC、HC和IAG差异有统计学意义(P<0.05),而ADC、VAG两组间差异无统计学意义(P>0.05);A、C两组间比较:LC、HC和IAG差异有统计学意义(P<0.05),而ADC、VAG两组间差异无统计学意义(P>0.05)。B、C两组间比较所有测量指标均无显著差异(P>0.05)。

结论

喙突越长、位置越低、肩胛盂倾斜角越小越易导致STT;ADC、VAG与STT无显著相关性。

Background

Subscapularis tendon tear (STT) is one of the leading causes of shoulder joint pain in middle-aged and older adults. Current studies on the mechanism of subscapularis tendon tear mainly include degeneration of the tendon itself, trauma, blood supply reduction, and subcoracoid impingement. The subcoracoid impingement is often ignored in physical examination and MRI, and it is only noticed if the patient has persistent pain or if the symptoms of anterior shoulder pain are not relieved after subacromial decompression. The commonly used method for subcoracoid impingement measurement is to measure the shortest distance from the coracoid tip to the humeral head in the axial position of MRI, the coracoid-humeral distance (CH) . This measurement method is greatly affected by the projection angle or the rotation angle of the humeral head and cannot accurately reflect the position of the coracoid tip.

Objective

To investigate the correlation between the shape and position of the coracoid process and subscapularis tendon tear (STT) .

Methods

We retrospectively collected the imaging data of shoulder joint of patients with degenerative rotator cuff tear after arthroscopy and healthy people. They were divided into rotator cuff tears with STT group (group A, n = 28) , rotator cuff tear without STT group (group B, n = 26) , and healthy group (group C, n = 22) . The Mimics software was used to establish the three-dimensional modeling of the scapula and evaluate the positions of the coracoid process and scapular glenoid. The length of the coracoid (LC) , the anteroposterior distance of the coracoid (ADC) , the height of the coracoid (HC) , the version angle of the glenoid (VAG) , and the inclination angle of the glenoid (IAG) were measured, and the parameters of each group were analyzed and compared.

Result

The LCs in groups A, B and C were (21.32 ±3.83) mm, (18.95 ±2.36) mm, and (17.75 ±2.69) mm, respectively. The ADCs in groups A, B, and C were (23.52±4.04) mm, (22.83±2.37) mm, and (24.03±3.65) mm, respectively. The HCs in groups A, B, and C were (20.76±3.35) mm, ( 23.33±2.7) mm, and (22.86±3.64) mm, respectively. The VAGs in groups A, B, and C were (-2.99±3.27) °, (-2.28±4.9) ° and (-2.83±4.4) °, respectively. The IAGs in group A, B, and C were 107.82° (101.59-112.04) °, 110.19° (105.86-118.72) ° and 110.37° (104.9-118.02) °, respectively. There were significant differences in LC, HC, and IAG between group A and group B (P<0.05) , but there was no significant difference in ADC and VAG between the two groups (P>0.05) . There were significant differences in LC, HC, and IAG between group A and group C (P<0.05) , but there was no significant difference in ADC and VAG between the two groups (P>0.05) . There was no significant difference in all the measured indexes between group B and group C (P>0.05) .

Conclusion

The longer the coracoid process, the lower the position and the smaller the inclination angle of the glenoid, the more likely it to cause subscapular tendon tears. However, the ADC and VAG are not significantly related to the subscapular tendon tears.

图1 三维重建后的肩胛骨模型 肩胛骨三维重建外侧面观(A);肩胛骨三维重建后面观(B);肩胛骨三维重建上面观(C);肩胛骨三维重建前面观(D) I点(关节盂最下方的点)、A点(关节盂最前方点)、P点(关节盂最后方点)、S点(肩胛下角最低点)、M点(肩胛冈与肩胛骨内缘交汇点)、D点(喙突最远端点即喙突尖)、O点(通过I点,A点和P点的关节盂的最佳拟合圆的中心点)
图2 肩胛骨三维模型平面建立 关节盂平面S1的建立(A);肩胛骨平面S2的建立(B、C);肩胛骨垂直平面S3的建立(D)
图3 3-matic软件距离测量 测量喙突长度(A);测量喙突前后间距(B);测量喙突高度(C);测量喙突数据图(D)
图4 3-matic软件角度测量 测量肩胛盂平面前后倾角(A);测量肩胛盂平面倾斜角(B)
表1 3组患者基本资料比较
表2 3组患者HC、ADC、LC、VAG和IAG比较
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