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中华肩肘外科电子杂志 ›› 2026, Vol. 14 ›› Issue (03) : 175 -180. doi: 10.3877/cma.j.issn.2095-5790.2026.03.007

综述

肩袖脂肪变性研究进展
毕春1, 丁启龙2, 王琦1, 吴晓明1, 吴剑宏1,()   
  1. 1201620 上海交通大学医学院附属第一人民医院创伤临床医学中心
    2811600 西宁市第二人民医院骨科
  • 收稿日期:2026-02-09 出版日期:2026-08-05
  • 通信作者: 吴剑宏
  • 基金资助:
    上海市松江区科技攻关项目(2024SJKJGG056)

Progress in research on rotator cuff fatty infiltration

Chun Bi, Qilong Ding, Qi Wang   

  • Received:2026-02-09 Published:2026-08-05
引用本文:

毕春, 丁启龙, 王琦, 吴晓明, 吴剑宏. 肩袖脂肪变性研究进展[J/OL]. 中华肩肘外科电子杂志, 2026, 14(03): 175-180.

Chun Bi, Qilong Ding, Qi Wang. Progress in research on rotator cuff fatty infiltration[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2026, 14(03): 175-180.

肩袖损伤是临床常见肌肉软组织疾病,肩袖脂肪变性作为影响修复疗效的关键因素之一,已成为研究热点。本文系统综述肩袖脂肪变性的流行病学特征、发生机制、诊断技术、临床特征及治疗策略,总结当前研究挑战与未来方向,为临床诊疗与科研提供参考。

图1 肩关节Grashey位X线片及肩袖超声三点量表 图A:肩峰下硬化、外侧骨赘及肱骨头肩峰间距;图B:正常冈上肌超声表现;图C:肩袖脂肪变性冈上肌超声表现[14]
表1 不同影像学方法优缺点总结表
图2 肩袖脂肪变性Goutallier CT分级(图A)[16,17]与Fuchs改良MRI分级(图B)[18,19]注:0级为肌肉无脂肪变性;1级为肌肉内见少量脂肪条索;2级为脂肪变性较明显,脂肪比例<50%;3级为脂肪与肌肉比例大致相等;4级为脂肪比例>50%,脂肪多于肌肉;MRI为磁共振成像
图3 MRI典型征象 图A-B:鱼刺征:T1WI示冈上肌全层撕裂伴进行性脂肪变性,肌束间脂肪条纹呈鱼刺样排列,提示Goutallier 3级及以上脂肪退变;图C-D:黑鸟征:T1WI示冈上肌后上部萎缩内陷,呈"鸟首前倾"样改变,内侧与下部保留正常形态,萎缩区为脂肪组织填充,提示冈上肌早期萎缩;图E-F:切线征:矢状斜位T1WI,肩胛冈与喙突上缘连线为切线,冈上肌萎缩致肌腹下缘低于切线为阳性,提示重度萎缩;图G-H:占位比率:矢状斜位T1WI,肩胛冈-喙突Y形层面,冈上肌横截面积与冈上肌窝横截面积比值,为评估冈上肌萎缩的半定量指标[20]
图4 Dixon序列水脂分离成像:3T矢状位两点法Dixon MRI可定量评估脂肪性肌退变 图A:同相位图;图B:反相位图;图C:脂肪分数定量图,经图像分割(红:冈上肌,蓝:冈下肌,绿:肩胛下肌)可精准测量各肌肉脂肪分数及三维体积;图D:整块肌肉平均脂肪分数与体积定量结果[23]
图5 横断位3T扩散张量成像 图A-B:左肩冈上肌腱术后慢性再撕裂,肌腱回缩(箭头),肌纤维羽状角(α)增大;图C-D:右肩健康冈上肌对照,肌腱长度正常,羽状角更小注:图A和图C为彩色编码纤维束追踪图;图B和图D为T1WI图
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