峰盂角的定义及临床研究进展

Definition and clinical progress of critical shoulder angle

肩袖损伤及退行性盂肱骨关节炎是由多种因素共同作用导致的疾病。现有的研究发现肩袖损伤与肩峰向外侧延伸程度以及肩胛盂的倾斜度有关。峰盂角指在肩关节正位X线片上肩胛盂上、下缘顶点连线与肩胛盂最下缘和肩峰最外侧下缘顶点连线的夹角,是综合反映在冠状面上肩胛盂倾斜程度和肩峰向外侧延伸程度的指标。峰盂角数值与肩袖损伤和盂肱关节骨关节炎关系密切。当峰盂角(>35°)较大时,常伴随肩袖损伤;而峰盂角(<30°)较小时,可能导致盂肱关节骨关节炎。因此,通过测量峰盂角数值有助于诊断肩袖损伤和盂肱关节骨关节炎。通过关节镜下肩峰外侧截骨术校正异常的峰盂角也为肩关节疾病的治疗提供了新的思路。从峰盂角的定义、测量、生物力学意义、治疗及人种差异等五个方面对峰盂角的研究进展进行综述。

Rotator cuff disease and degenerative osteoarthritis are caused by many factors.Several studies had shown that rotator cuff disease was related to lateral extension of the acromion and glenoid inclination.A new parameter,critical shoulder angle(CSA),which is defined as the angle between a line connecting the superior to the inferior margins of the glenoid and a line connecting the inferior margin of the glenoid to the inferolateral edge of the acromion measured on anteroposterior(AP)shoulder radiographs,is proposed to comprehensively reflect the relationship between abnormal anatomical structure and rotator cuff injury.There is a close relationship between CSA and the injury of rotator cuff and the osteoarthritis of glenohumeral joint:the injury of rotator cuff is often accompanied by a larger CSA(>35°),and a smaller CSA(<30°)is closely related to the occurrence of glenohumeral arthritis.Therefore,CSA is helpful for the diagnosis of rotator cuff injury and glenohumeral osteoarthritis.Correction of abnormal CSA by arthroscopic lateral acromial osteotomy also provides a new idea for the treatment of shoulder diseases.In this paper,we reviewed the research progress of the angle from five aspects:definition,measurement,biomechanical significance,treatment and ethnic differences.