不同体位肩袖和肩峰下空间关系的相关性研究

The analysis of spatial relationship between the rotator cuff and the subacromial space in different arm positions

目的 检测正常肩关节在不同体位时肩峰和锁骨外侧点至肱骨头之间最短距离是否会发生变化 ,并分析其意义。方法 对肩关节处于 6个不同外展体位的 15例正常志愿者进行肩关节MR冠状面薄层扫描 ,观察、测量肩峰外侧点到肱骨头之间的最短距离 (A H)、锁骨外侧点到肱骨头之间的最短距离 (C H)、肩峰下空间和肩袖的位置关系。结果 A H值和C H值在肩关节处于 6 0°、90°、12 0°、15 0°外展体位时 (A H值分别是 1 0 5 1、1 0 84、0 96 1和 0 95 0cm ;C H值分别为 1 5 4 8、1 5 4 8、1 5 2 9和 1 4 96cm)明显小于 0°、30°外展体位时 (A H值分别为 1 2 6 1和 1 2 5 7cm ;C H值分别为 1 96 3和 1 930cm) (F值分别为 8 76和 15 5 1,P值均 <0 0 1) ;而 0°与 30°体位间A H及C H值比较 ,以及 6 0°、90°、12 0°、15 0°体位间A H及C H值两两比较 ,P值均 >0 0 5。 15例肩关节处于6 0°、90°、12 0°外展体位时 ,肩袖 (主要是冈上肌肌腱 )刚好从肩峰和肱骨头之间穿过。结论 肩关节处于 6 0°、90、12 0°外展体位时 ,肩峰下空间缩小 ,且肩袖刚好从中穿过 。

Objective To explore the distance between the acromion and the humerus head at different arm abduction to observe whether it changes or not, to determine at which position the distance is smallest, and to evaluate the relationship between the subacromial space and the rotator cuff Methods Fifteen normal volunteers were examined with MRI in six arm positions, and the coronal thin images were obtained with a spin echo sequence Using a special positioning device, the arm was placed at 0°, 30°, 60°, 90°, 120°, and 150° arm abduction, respectively Of them, 0°-90° positions were not rotated, while 120° and 150° positions were slight internal rotated The minimal distance of acromion humerus (A H) and clavical humerus (C H), and the spatial relationship between the rotator cuff and the subacromial space were measured and observed Results The values of A H and C H at 60°-150° arm abduction were obviously smaller than those at 0°-30° arm abduction ( P <0 01) But the values of A H and C H among 60°, 90°, 120°, and 150° arm abduction had no statistical differences ( P >0 05) The rotator cuff (mainly supraspinatus tendon) just went through between the acromion and the humerus at 60°-120° arm positions but not at 0°, 30°, and 150° arm positions So at 60°-120° arm positions, rotator cuff between the humerus and the acromion was often impinged Conclusion The closest contact between the supraspinatus tendon and subacromial space occurs at 60°-120° abduction The findings testify that the patients with impingement syndrome have shoulder pain at 60°-120° abduction in clinic from etiology and pathology In the future, MRI based analyses should allow investigating the morphological basis of the impingement syndrome, choosing the appropriate therapy, and minimizing failure rates of surgery