退变型肩袖撕裂合并外伤的微观骨结构变化及相关性研究

Microstructural changes and correlation of microstructural changes and correlations in trauma-induced degenerative rotator cuff tear

目的探讨外伤致退变型肩袖撕裂(RCT)与单纯退变损伤之间的微观骨质结构差异,分析外伤组骨性结构改变与RCT程度的相关性。方法收集156例患者的影像学资料(X线、CT、MRI),外伤患者共110例,简称T组;单纯退变损伤共46例,为D组。根据影像学划分肩峰形态和RCT的类型,测量RCT的大小、CSA(关键性肩角)、AGA(肩峰关节盂角)、AT(肩峰倾斜度)和AHD(肩肱间距)共7个指标。比较两组基础资料和指标的差异;分析关节镜和MRI评估RCT大小的一致性和相关性;对影响T组撕裂大小和类型的因素进行相关性分析。结果D组发病至确诊时间、手术时间﹥T组,RCT长度<T组;关节镜评估RCT长度﹥MRI,两者无一致性,但有相关性;RCT大小与AHD呈负相关,全层撕裂与Ⅲ型肩峰有关。结论非严重暴力伤致退变型RCT的微观骨结构不发生改变,外伤使肩袖撕裂长度增大,但撕裂的大小和类型主要受AHD和Ⅲ型肩峰的影响。以关节镜结果作为鉴定依据,肩袖撕裂的长度存在被放大的可能。

Objective To explore the microscopic bone structure differences between traumatic degenerative rotator cuff tear(RCT) and degenerative injury, and to analyze the correlation between bone indexes and the degree of RCT in trauma group.Methods The imaging data(X-ray, CT, MRI) were collected from 156 patients, including 110 patients with trauma(group T)and 46 patients with simple degenerative injury(group D). According to the imaging classification of acromion as well as RCT, 7factors were investigated, including the size of RCT, CSA(critical shoulder angle), AGA(acromial glenoid angle), AT(acromion inclination) and AHD(shoulder-brachial distance). The differences of the parameters between the two groups were compared.The consistency and correlation between the assessments of RCT size based on arthroscopy and MRI respectively were analyzed.Correlation analysis was conducted on the factors affecting the tear size and type of T group. Results The time from incidence to diagnosis of group D were longer than that of group T. So is the time from incidence to and operation. The RCT length of group D is less than that of group T. The length of arthroscopic RCT was longer than that of MRI, which were inconsistent but relevant. The size of RCT was negatively correlated with AHD, and full-thickness tear was relavent with type-Ⅲ-acromion. Conclusion The bone structure of degenerative RCT caused by non-severe violence injury will not change. Trauma can increase the tear length of rotator cuff, however, the size and type of tear are mainly influenced by AHD and type-Ⅲ-acromion. The length of rotator cuff tear may be enlarged when arthroscopic results are used as the identification basis.