三维CT重建肩胛下肌损伤的相关因素及预测效能评估  

Factors associated with subscapularis injury and predictive efficacy based on three-dimensional CT reconstruction

作　　者：李大恩 武亚飞 仇尚 王刚 高绪仁 陈向阳 Li Daen;Wu Yafei;Qiu Shang;Wang Gang;Gao Xuren;Chen Xiangyang(Department of Orthopedics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院骨科,江苏省徐州市221000 [2]徐州医科大学,江苏省徐州市221000

出　　处：《中国组织工程研究》2023年第27期4351-4356,共6页Chinese Journal of Tissue Engineering Research

基　　金：徐州市科学技术局项目(KC19019),项目负责人:仇尚。

摘　　要：背景:肩胛下肌作为肩袖肌群中最大且唯一的前肩袖肌,其损伤时常被忽视,且肩胛下肌局部损伤仍具有诊断难度,近年来有研究发现喙肱距及喙突过度覆盖距离可作为肩胛下肌损伤的预测因子。目的:探究喙肱距离、喙突过度覆盖距离及患者双侧肩关节喙肱距差异与肩胛下肌损伤的关系,评估各参数对肩胛下肌损伤的诊断效能。方法:回顾性收集2021年2月至2022年6月退变性肩袖损伤患者的术前临床及影像学资料,根据术中关节镜检查结果将患者分为肩袖损伤合并肩胛下肌撕裂组(肩胛下肌撕裂组,28例),肩袖损伤不伴有肩胛下肌撕裂组(对照组,56例)。将入组患者的CT资料以DICOM格式导入Mimics软件,重建患者肩胛骨及肱骨近端,确定测量点建立测量平面,在3-matic软件测量患者喙肱距离、喙突过度覆盖距离。比较两组患者组间参数差异及组内双侧差异,并对各参数进行受试者工作特征曲线分析,确定各参数曲线下面积及最佳截断值。结果与结论:(1)组间比较喙肱距离:肩胛下肌撕裂组为(7.00±0.87) mm,对照组为(9.08±1.02) mm,肩胛下肌撕裂组明显小于对照组(P <0.01);组间比较喙突过度覆盖距离:肩胛下肌撕裂组为(21.05±1.98) mm,对照组为(19.46±1.55) mm,肩胛下肌撕裂组明显大于对照组(P <0.01);(2)组内比较双侧喙肱距差异:肩胛下肌撕裂组患侧喙肱距离(7.00±0.87)mm明显小于健侧(9.26±0.87)mm,差异有显著性意义(P<0.01);(3)受试者工作特征曲线分析:喙肱距离、喙突过度覆盖距离、双侧喙肱距差异的曲线下面积(AUC)分别为0.884,0.729,0.905;最佳截断值分别为7.65,20.2,1.15 mm;(4)结果表明,喙肱距离、喙突过度覆盖距离、双侧喙肱距差异均与肩胛下肌损伤有关,均可作为肩胛下肌损伤的预测因子,其中双侧喙肱距差异的预测效能最高,3个测量参数在临床术前诊断可提供一定参考价值。BACKGROUND: As the largest and only anterior rotator cuff muscle in the rotator cuff muscle group, the subscapularis muscle is often neglected for its injury,and the local injury of the subscapular muscle is still difficult to diagnose. In recent years, studies have found that the coracohumeral distance and coracoid overlap distance were used as predictors of subscapularis muscle injury.OBJECTIVE: To investigate the relationship between the coracohumeral distance, coracoid overlap distance and the difference between the coracohumeral distance of the patient’s bilateral shoulder joint and subscapularis injury, and to evaluate the diagnostic efficacy of each parameter on subscapularis injury.METHODS: Preoperative clinical and imaging data of patients with degenerative rotator cuff injury from February 2021 to June 2022 were retrospectively collected, and patients were divided into the group with rotator cuff injury combined with subscapularis tear(subscapularis tear group, 28 patients) and the group with rotator cuff injury without subscapularis tear(control group, 56 patients) based on intraoperative arthroscopic findings. The CT data of the enrolled patients were imported into Mimics software in DICOM format. The scapula and proximal humerus of the patients were reconstructed;the measurement points were determined to establish the measurement plane;the coracohumeral distance and coracoid overlap distance of the patients were measured in 3-matic software. The differences in parameters between the two groups of patients and bilateral differences within the groups were compared, and receiver operating characteristic curve analysis was performed for each parameter to determine the area under the curve and the optimal cut-off value for each parameter.RESULTS AND CONCLUSION:(1) Coracohumeral distance among groups:(7.00±0.87) mm in the subscapularis tear group and(9.08±1.02) mm in the control group. Coracohumeral distance in the subscapularis tear group was significantly smaller than that in the control group(P < 0.

关 键 词：肩袖损伤 肩胛下肌损伤 喙肱距 喙突过度覆盖距离 三维重建 肩胛骨 喙突 

分 类 号：R445[医药卫生—影像医学与核医学] R318[医药卫生—诊断学] R684[医药卫生—临床医学]