肩胛骨个体解剖形态测量对肩袖损伤诊断的预测价值

Value of individual anatomical measurement of the scapula to the prediction of rotator cuff injury

目的探讨肩胛骨个体化解剖形态与肩袖损伤的关系。方法肩关节疾病患者71例,其中40例肩袖损伤患者为肩袖损伤组,31例非肩袖损伤患者为非肩袖损伤组。比较2组患者性别、年龄、肩关节临界角(critical shoulder angle,CSA)及外侧肩峰角(lateral acromion angle,LAA),采用多因素logistic回归分析肩袖损伤的影响因素;绘制ROC曲线,评估LAA和CSA对肩袖损伤的诊断效能。结果肩袖损伤组患者年龄[(54.8±11.5)岁]、CSA[(40.6±4.7)°]明显大于非肩袖损伤组[(47.7±11.4)岁、(36.8±5.5)°](P<0.05),LAA[(70.9±7.0)°]小于非肩袖损伤组[(76.5±7.2)°](P<0.05)。年龄(OR=0.952,95%CI:0.911~0.994,P=0.027)、LAA(OR=1.114,95%CI:1.034~1.199,P=0.004)及CSA(OR=0.844,95%CI:0.752~0.947,P=0.004)是肩袖损伤的影响因素。当年龄、LAA、CSA最佳截断值分别为55.50岁、72.67°、37.10°时,预测肩袖损伤的AUC分别为0.680(95%CI:0.554~0.805,P=0.010)、0.719(95%CI:0.597~0.840,P=0.002)、0.737(95%CI:0.612~0.862,P=0.001),LAA、CSA对肩袖损伤有一定预测效能(AUC>0.7),年龄对肩袖损伤的预测效能较差。结论CSA和LAA均是肩袖损伤的影响因素;肩关节CSA增大,LAA减小提示肩袖损伤。

Objective To investigate the relationship between the individual anatomy morphology of the scapula and rotator cuff injury.Methods In 71 patients with shoulder joint disease,there were 40 patients with rotator cuff injury(rotator cuff injury group)and 31 patients without rotator cuff injury(non-rotator cuff injury group).The gender,age,critical shoulder angle(CSA)and lateral acromion angle(LAA)were compared between two groups.The relationships of the LAA and CSA with rotator cuff injury were analyzed by multivariate logistic regression.ROC curve was drawn to evaluate the diagnostic efficiencies of the LAA and CSA on rotator cuff injury.Results The patients were older and the CSA was larger in rotator cuff injury group((54.8±11.5)years,(40.6±4.7)°)than those in non-rotator cuff injury group((47.7±11.4)years,(36.8±5.5)°)(P<0.05),while the LAA((70.9±7.0)°)was smaller than that in non-rotator cuff injury group((76.5±7.2)°)(P<0.05).The age(OR=0.952,95%CI:0.911-0.994,P=0.027),LAA(OR=1.114,95%CI:1.034-1.199,P=0.004)and CSA(OR=0.844,95%CI:0.752-0.947,P=0.004)were the influencing factors of rotator cuff injury.When the optimal cut-off values of the age,LAA and CSA were 55.50 years,72.67°and 37.10°,the AUCs for predicting rotator cuff injury were 0.680(95%CI:0.554-0.805,P=0.010),0.719(95%CI:0.597-0.840,P=0.002)and 0.737(95%CI:0.612-0.862,P=0.001),respectively.The LAA and CSA had certain predictive efficiencies on rotator cuff injury(AUC>0.7),while the age had poor predictive effect on rotator cuff injury.Conclusion Both CSA and LAA are the influencing factors of rotator cuff injury,and the enlarged CSA and decreased LAA indicate rotator cuff injury.