MSCT在肩峰分型及其与肩峰下撞击综合症的相关性的应用研究

目的 探讨肩峰分型及其与肩峰下撞击综合症的相关性。方法 选择经临床证实的97例肩峰下撞击综合症患者,按年龄段分成A组（39岁以下）、B组（40～59岁）和C组（60岁以上）三组,共97个肩关节进行MSCT扫描,将原始数据1mm薄层重建后在工作站上行容积再现（VR）、多平面重组（MPR）、最大密度投影（MⅠP）等后处理,观察肩峰解剖形态并分型、测肩峰-肱骨头间距（A-H间距）。结果 Ⅰ型扁平型23肩,占23.7%,Ⅱ型弯曲型30肩,占30.9%,Ⅲ型钩型44肩,占45.4%;Ⅰ、Ⅱ型肩峰所占比例随年龄增加而减少,Ⅲ型肩峰随年龄增加而增多,A、B组及A、C组Ⅱ、Ⅲ肩峰比例差异有统计学意义;Ⅰ型和Ⅱ型肩峰在左、右肩分布无明显差异,Ⅲ型肩峰以右肩居多,左右肩Ⅲ型肩峰比例差异有统计学意义;Ⅰ、Ⅲ型及Ⅱ、Ⅲ型肩峰A-H间距〈5mm组比例差异有统计学意义,Ⅲ型所占比例最高。结论 MSCT可以清晰显示肩关节的解剖及其形态,钩型肩峰以右肩多见,且随年龄增加而增加,肩峰下撞击综合症的发生率明显高于其他两型。

Study on the classification of acromion and its correlationship to the morbidity of the subacromial impingement syndrome using MSCT

Objective To discuss the correlationship of acromion classification and morbidity of the subacromial impingement syndrome. Methods 97 patients diagnosed as subacromial impingement syndrome were divided into three groups according to the age, Group A（≤39 yrs）, Group B （40~59 yrs） and Group C （~60 yrs）. All glenohumeral joints of the 97 cases underwent multi slice spiral computed tomography （MSCT） scanning and three dimensional reconstructed at 1 mm thin slices. Then volume rendering （VR）, multi-planar reconstruction （MPR） and maximum intensity projection （MIP） were taken to observe the anatomy and the classification of the joints, additionally, the distance of the acromial-humeral gap （A-H gap） was measured. Results 23. 7 percent of the cases （23/97） were type I （flat shoulder）, 30.9 percent （30/97） were type Ⅱ （arc-shaped shoulder）, 45.4 percent （44/97） were type Ⅲ （hook-shaped shoulder）. The proportion of type I and Ⅱ decreased with increasing age, but type Ⅲ increased. The proportion of type Ⅱ was significantly different between Group A and B, Group A and C, so did type Ⅲ. There was no significant difference proportion of type I and Ⅱ between the left and right shoulder. Type Ⅲ were seen more frequently in the right shoulder, which was significantly less in the left side. The proportion of A-H interval 〈5mm part was statistically different between type I and Ⅱ , type I and Ⅲ, furthermore, which was the highest in type Ⅲ. Conclusion MSCT can clearly show the anatomy and morphology of the shoulder joint. The hook-shaped shoulder is more frequent in the right side, and increases with increasing age, the morbidity of subacromial impingement syndrome are significantly higher than that of the other two groups.