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中华肩肘外科电子杂志 ›› 2024, Vol. 12 ›› Issue (04) : 326 -331. doi: 10.3877/cma.j.issn.2095-5790.2024.04.007

所属专题: 经典病例

论著

肩肱距离在肩痛患者诊断和治疗决策中的作用:一项回顾性的病例对照研究
谢娜1, 纪东旭2, 刘晨3, 徐峰1,()   
  1. 1.102206 北京大学第八临床医学院北京大学国际医院康复科
    2.102206 北京大学第八临床医学院北京大学国际医院放射科
    3.102206 北京大学第八临床医学院北京大学国际医院骨科
  • 收稿日期:2024-03-28 出版日期:2024-11-05
  • 通信作者: 徐峰
  • 基金资助:
    北京大学医学部合作研究(横向课题2023-006)

The role of scapulohumeral distance in diagnosis and treatment decisions in patients with shoulder pain:a retrospective case-control study

Na Xie1, Dongxu Ji2, Chen Liu3, Feng Xu1,()   

  1. 1.Department of Rehabilitation, Peking University International Hospital, Beijing 102206, China
    2.Department of Radiology,Peking University International Hospital, Beijing 102206, China
    3.Department of Orthopedics, Peking University International Hospital, Beijing 102206, China
  • Received:2024-03-28 Published:2024-11-05
  • Corresponding author: Feng Xu
引用本文:

谢娜, 纪东旭, 刘晨, 徐峰. 肩肱距离在肩痛患者诊断和治疗决策中的作用:一项回顾性的病例对照研究[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 326-331.

Na Xie, Dongxu Ji, Chen Liu, Feng Xu. The role of scapulohumeral distance in diagnosis and treatment decisions in patients with shoulder pain:a retrospective case-control study[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(04): 326-331.

目的

通过比较手术和非手术治疗的肩峰下疼痛综合征(subacromial pain syndrome,SAPS)患者之间的肩肱距离(acromiohumeral distance,AHD)、Constant-Murley肩关节功能评分(Constant shoulder score,CMS)以及肩袖撕裂(rotator cufftear,RCT)的严重程度的差异,重新评估AHD 在RCT 患者的诊断和治疗决策中的作用。

方法

回顾性病例对照研究纳入本院2019~2023 年的患者,分为手术治疗组(n=93)和非手术治疗组(n=116),测量和统计分析AHD、CMS、RCT 撕裂程度等数据。两组患者在年龄、性别和肩痛的位置方面具有可比性。

结果

手术组内的AHD 差异小于非手术组,但差异无统计学意义(P >0.05)。手术组的CMS 明显低于非手术组(P <0.001)。手术组的RCT 撕裂程度明显高于非手术组(P >0.001)。AHD 与CMS 之间的Pearson 相关分析显示为弱相关或无相关性(P >0.05)。Spearman 相关分析显示,CMS 与RCT 撕裂程度(P <0.001)之间存在显著相关性。而AHD 与RCT 撕裂程度间差异无统计学意义(P =0.797)。

结论

非手术治疗与手术治疗的SAPS 患者术前AHD 差异无统计学意义,成人SAPS 患者的AHD 与肩功能和RCT 之间不存在线性关系,不支持肩峰下间隙减少作为SAPS 的病因机制的理论。RCT 患者的手术或非手术治疗应关注肩关节功能和RCT 的程度,肩峰下间隙AHD 减少的潜在价值最小。

Background

Shoulder pain is the third most common musculoskeletal disorder, and the most common diagnosis is subacromial pain syndrome (SAPS), also known as “shoulder impingement syndrome (SIS).” A decrease acromiohumeral distance (AHD) resulting in subacromial structure impingement below the acromion is generally considered a significant cause of SAPS. Both surgical and nonsurgical treatments were designed to increase AHD in patients with SAPS. However, previous studies have produced conflicting results regarding the link between AHD and symptoms. In addition, there is no consensus on the mechanism of SAPS. Whether preoperative AHD is reduced in patients undergoing shoulder surgery compared to nonsurgical patients has not been thoroughly studied.

Objective

To reevaluate the role of AHD in diagnosis and treatment decision-making in patients with SAPS by comparing the differences in AHD and Constant-Murley shoulder function score (CMS) and rotator cufftear (RCT)between surgical and nonsurgical patients.

Methods

A retrospective case-control study included patients in our hospital from 2019 to 2023, divided into surgical treatment group (n=93) and nonsurgical treatment groups (n=116). The AHD, CMS, and RCT tear degree data were measured and statistically analyzed. The two groups were comparable in age, sex, and location of shoulder pain.

Results

The difference in AHD in the operation group was smaller than that in the non-operation group, but the difference was not statistically significant (P>0.05). CMS in the surgical group was significantly lower than in the nonsurgical group(P<0.001). The degree of RCT tear in the surgical group was significantly higher than in the nonsurgical group (P<0.001). The Pearson correlation analysis between AHD and CMS showed weak or no correlation(P>0.05). Spearman correlation analysis showed a significant correlation between CMS and RCT tear degree (P<0.001). There was no significant difference in the degree of tear between AHD and RCT(P=0.797).

Conclusion

Our findings suggest that there is no statistical difference in preoperative AHD between non-operative and operative SAPS patients and that there is no linear relationship between AHD and shoulder function and rotator cufftear in adult SAPS patients, which does not support the theory of reduced subacromial space as an etiological mechanism of SAPS. Surgical or nonsurgical treatment of RCT patients should focus on shoulder function and the extent of rotator cufftear, with minimal potential value for AHD reduction in the subacromial space.

图1 AHD 测量方法。测量肱骨冠状头顶点与肩峰之间的最短距离,见冠状面斜位t1 加权Mr 图像(图A)。通过冠状面斜位pd 加权Mr 图像(图B)评估STT 的程度,EllmanIII 级:远端冈上肌腱全层撕裂(箭头)
表1 两种患者基本特征
表2 两组间CMS 的Mann-WhitneyU 检验及RCT 分级
图2 AHD 与CMS 之间的Pearson 相关性分析 注:AHD 为肩肱距离;CMS 为Constant-Murley 肩关节功能评分
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