肩关节退行性改变的临床研究

Effect of aging on degenerative changes of shoulder joint; a clinical and radiological study

目的评价肩关节退行性改变程度与年龄的关系及其临床表现。方法200例患者共400肩,男48例(24％),女152例(76％),年龄70-101岁,平均为(84．2±6．7)岁。病史询问和理学检查的结果按Constant方法予以评分。所有患者均摄双肩旋转中立位、正位X线片,观察肩峰下间隙宽度(AHD)及盂肱关节的改变程度,并按Hamada方法进行分类。结果AHD≥6mm 349肩(87．25％),平均为(9．89±2．00)mm,对应HamadaⅠ型,AHD< 6 mm 51肩,平均为(3．08±1．70)mm,其中HamadaⅡ型21肩(5．25％),Ⅲ型16肩(4．00％),Ⅳ型5肩(1．25％),V型5肩(1．25％),另有4肩(1．00％)不能按Hamada分型进行归类。Hamada分型越高,Constant评分值越低。288肩(72．00％)盂舷关节间隙正常,93肩(23．25％)盂肱关节间隙正常但伴肱骨头或肩胛盂下方的骨赘形成,19肩(4．75％)盂肱关节狭窄或消失。随着盂肱关节间隙狭窄的程度加剧,Constant评分值降低,肩峰下间隙狭窄的发生率随之升高。在盂肱关节间隙改变的被调查者中,50％伴有肩峰下间隙的狭窄或消失。结论肩袖撕裂的发生率随年龄的增长而升高,但盂肱关节骨关节炎的发生率仅有轻微升高。单纯的肩峰下间隙狭窄或消失的临床症状较轻,而盂肱关节间隙狭窄伴或不伴AHD改变的临床症状剧烈,表现为肩关节疼痛和关节僵硬。

Objective To assess the effect of aging on the degenerative changes of shoulder joint based on clinical and radiological grounds in 200 patients aged between 70 to 101 years. Methods The cohort was composed of 48 men（24%） and 152 women（76%）, aged （84.24±6.7） years. All patients underwent a physical examination by Constant score. The radiographic examination included an AP view in neutral rotation of both shoulders. The Hamada classification was used to stage full thickness cuff tears. The glenohumeral compartment was analyzed to search for osteophyte formation and joint space narrowing. Results The subacromial space height was greater than 6 mm [mean （9. 894±2.00） mm], in 349 shoulders（87.25% ）, corresponding to stage Ⅰ in the Hamada classification, and measured less than 6 mm [mean （3.08 ± 1.70） mm], in 51 shoulders （ 12.75 % ）. The Hamada classification for the other shoulders was stage Ⅱ （21 shoulders, 5. 25%）, and stage Ⅲ （16 shoulders, 4.00%）, stage Ⅳ （5 shoulders, 1.25%） and stage Ⅴ （5 shoulders, 1.25%） , undetermined in the rest four shoulders. There was a strong statistical correlation between the Constant score and Hamada staging. The glenohumeral space was normal in 288 shoulders（72.00 % ）. Ninety-three shoulders（23.25%） in 62 patients（31%） presented humeral and/or inferior glenoid osteophytes without glenohumeral impingement and 19 shoulders（4.75 % ） in 14 patients（7 % ） presented complete glenohumeral impingement. There was a significant correlation between the Constant score and severity of the glenohumeral degradation. The proportion of subacromial impingement increased significantly and regularly with degradation of the glenohumeral space. For half of the shoulders, glenohumeral impingement was associated with subacromial impingement （eccentric osteoarthritis）. Conclusions The results of this study confirm that the frequency of rotator cuff tears increases with age. Clinical tolerance of subacromial impingement or subacromial osteoarthritis is good but glenohumeral impingement, associated with or without subacromial impingement is poorly tolerated with shoulder pain and marked stiffness.Our results demonstrate that degenerative changes of the shoulder does not exhibit a regular linear relationship with Homada radiological classification.（Shanghai Med J,2006,29：728-732）