MRI测量肩关节骨性参数与肩袖退变性撕裂相关性研究

Correlation Study between MRI Measurements of Shoulder Bony Parameters and Rotator Cuff Degenerative Tears

摘要: 目的：探讨MRI测量临界肩角(Critical Shoulder Angle, CSA)、肩峰指数(Acromial Index, AI)、肩肱间距(Acromio Humeral Interval, AHI)与肩袖退变性撕裂之间的关系。方法：回顾性搜集2021年1月至2023年1月来院就诊的肩痛患者的MRI图像，共565例，其中肩袖退变性撕裂组353例，对照组212例，且均通过MRI或关节镜证实。在MRI图像上分别测量CSA、AI、AHI数值，用方差分析及Spearman检验对CSA、AI、AHI进行统计学分析，并采用受试者工作特征曲线(Receiver Operator Characteristic Curve, ROC)确定CSA、AI、AHI诊断肩袖退变性撕裂的分界值及其敏感性和特异性。结果：1) CSA、AI撕裂组大于对照组，AHI撕裂组小于对照组，差异均有统计学意义(p < 0.05)；2) CSA、AI具有相关性；3) CSA的曲线下面积、与肩袖撕裂灵敏性及特异性最高；诊断肩袖撕裂的最佳分界点：CSA为34.25˚、AI为0.66、AHI为7.01 mm。结论：MRI对CSA、AI及AHI的测量在肩袖退变性撕裂诊断中均具有价值，其中CSA的诊断效能最高。

Abstract: Objective: To investigate the relationship between MRI measurement of critical shoulder angle (CSA), acromial index (AI), acromio humeral interval (AHI), and rotator cuff degenerative tear. Methods: MRI images of 565 patients with shoulder pain who came to our hospital from January 2021 to January 2023 were retrospectively collected, including 353 in the rotator cuff degenerative tear group and 212 in the control group, all of which were confirmed by MRI or arthroscopy. The CSAs were measured on MRI images, AI, and AHI, with analysis of variance and Spearman correlation for the statistical analysis of CSA, AI, and AHI, and adopted the receiver-operating characteristic curve (ROC) to determine the boundary values of CSA, AI, and AHI in the diagnosis of rotator cuff degenerative tears and their sensitivity and specificity. Results: 1) CSA and AI tear groups were larger than control group, AHI tear group was smaller than control group, the differences were statistically significant (p < 0.05); 2) CSA and AI are relevant; 3) CSA had the highest sensitivity and specificity in area under the curve and rotator cuff tear; The best cut-off points for diagnosing rotator cuff tears were 34.25˚ CSA, 0.66 AI, and 7.01 mm AHI. Conclusion: MRI measurement of CSA, AI, and AHI is valuable in the diagnosis of rotator cuff degenerative tear, and CSA is the most valuable.