[1]周红海△,黄新冰,黄明翥,等.基于肩部正位片的肩周炎关节形态及力学特征分析[J].中国中医骨伤科杂志,2024,32(10):6-12.[doi:10.20085/j.cnki.issn1005-0205.241002]
　ZHOU Honghai,HUANG Xinbing,HUANG Mingzhu,et al.Analysis of Joint Morphology and Mechanical Characteristics of Scapulohumeral Periarthritis Based on Anteroposterior Radiographs of Shoulder[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(10):6-12.[doi:10.20085/j.cnki.issn1005-0205.241002]
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基于肩部正位片的肩周炎关节形态及力学特征分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年10期
页码:
6-12
栏目:
临床研究
出版日期:
2024-10-15

文章信息/Info

Title:
Analysis of Joint Morphology and Mechanical Characteristics of Scapulohumeral Periarthritis Based on Anteroposterior Radiographs of Shoulder
文章编号:
1005-0205(2024)10-0006-07
作者:
周红海1△; 黄新冰1; 黄明翥1; 罗灏1; 刘粮酺1
1广西中医药大学(南宁,530001)
Author(s):
ZHOU Honghai1△; HUANG Xinbing1; HUANG Mingzhu1; LUO Hao1; LIU Liangpu1
1Guangxi University of Chinese Medicine,Nanning 530001,China.
关键词:
肩周炎;  韧带;  肩锁关节;  生物力学;  影像学
Keywords:
shoulder periarthritis;  ligament;  acromioclavicular joint;  biomechanics;  imaging
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.241002
文献标志码:
A
摘要:
目的:基于肩部正位片分析肩周炎患者的肩关节形态及力学分布特征。方法:选取肩周炎患者30例作为研究对象(肩周炎组),20例正常人肩关节作为对照组,按分类标准分别将肩锁关节形态及肱骨大结节形态分为Ⅰ型、Ⅱ型、Ⅲ型,测量各组的肩肱距离、肩峰指数、喙突关节面至肩峰关节面的距离、肩锁间隙、锥状结节至锁骨关节面的距离、锥状结节与喙突指状突起之间的距离、喙突上锥形韧带与喙肩韧带附着点距离等指标,进行统计学处理,比较各组差异,分析肩部正位片观察到的肩关节及肩锁关节特征与肩周炎的关系。结果:肩周炎组与对照组之间肩锁关节形态及肱骨大结节分型差异无统计学意义(P>0.05),肩周炎组以Ⅱ型肩锁关节形态及Ⅲ型肱骨大结节形态为主。肩周炎组与对照组之间肩峰指数差异无统计学意义(P>0.05),肩肱距离差异有统计学意义(P<0.05),肩周炎组肩肱距离较对照组小。肩周炎组与对照组之间肩锁关节间隙距离b及喙突上锥形韧带与喙肩韧带附着点距离e差异无统计学意义(P>0.05); 肩周炎组与对照组之间喙突关节面至肩峰关节面的距离a、锥状结节至锁骨最外侧端的距离c、锥状结节与喙突指状突起之间的距离d及其围成的面积S,差异均有统计学意义(P<0.05),且肩周炎组均明显小于对照组。肩周炎组与对照组之间锁骨下斜方棘至喙突连线与c的夹角3差异有统计学意义(P<0.05),a与b的夹角1及c与d的夹角2差异无统计学意义(P>0.05)。面积S与a、c、d之间相关性分析差异有统计学意义(P<0.05),与b、e、夹角1、夹角2、夹角3之间相关性分析差异无统计学意义(P>0.05)。结论:肩周炎患者肩肱距离更小、喙肩韧带更短,其下软组织挤压摩擦增多; 肩关节竖直方向稳定性减弱,肩峰下间隙及肩袖间隙容积减小,会增加肩周炎的发生概率; 患者锥状结节至锁骨最外侧端的距离越小,喙肩韧带与锥形韧带越靠近,容易超出拉伸极限导致损伤; 斜方韧带受损造成的稳定性减弱,可能是导致肩周炎产生的一个诱因; 患者的肩关节稳定性减弱是因为韧带-核心稳定区域-肩关节的系列连锁变化,核心稳定区面积越小,则受力越大。
Abstract:
Objective:To analyze shoulder joint morphology and mechanical distribution characteristics in patients with periarthritis of the shoulder based on shoulder radiographs.Methods:30 patients with frozen shoulder were selected as the research subjects(shoulder periarthritis group),and 20 normal shoulder joints were selected as the control group.The morphology of the acromioclavicular joint and the morphology of the greater tuberosity of the humerus were classified into type Ⅰ,type Ⅱ,and type Ⅲ according to classification criteria.The shoulder-humerus distance,acromion index,distance from the coracoid process articular surface to the acromion articular surface,acromioclavicular gap,distance from the conoid tubercle to the clavicular articular surface,distance between the conoid tubercle and the coracoid process finger-like protrusion,distance between the conoid tubercle and the attachment point of the coracoclavicular ligament on the coracoid process,and other indicators were measured in each group.Statistical analysis was performed to compare the differences between each group and analyze the relationship between the characteristics of the shoulder joint and acromioclavicular joint observed on the shoulder radiograph and frozen shoulder.Results:There was no statistically significant difference in the morphology of the acromioclavicular joint and the classification of the greater tuberosity of the humerus between the shoulder periarthritis group and the control group(P>0.05).The shoulder periarthritis group mainly had type Ⅱ acromioclavicular joint morphology and type Ⅲ greater tuberosity of the humerus.The difference in shoulder peak index between the shoulder periarthritis group and the control group was not statistically significant(P>0.05),while the difference in shoulder humeral distance was statistically significant(P<0.05).The shoulder humeral distance in the shoulder periarthritis group was smaller than that in the control group.There was no statistical significance in the distance b between the acromioclavicular joint space and the distance e between the conical ligament of the superior coracoprocess and the coracoshoulder ligament between the periarthritis group and the control group(P>0.05).There were statistically significant differences between the periarthritis group and the control group in the distance a from the articular surface of coracoideus to acromialis articularis,the distance c from the conical tubercle to the most lateral end of the clavicle,the distance d from the conical tubercle to the digital process of coracoideus and the area S surrounding them(P<0.05),and the periarthritis group was significantly smaller than the control group.There was a statistically significant difference in the angle 3 between the subclavian oblique spine to coracoid process line and c between the shoulder periarthritis group and the control group(P<0.05),while there was no statistically significant difference in the angle 1 between a and b and the angle 2 between c and d(P>0.05).The correlation analysis between area S and distances a,c,d showed statistical significance(P<0.05),while there was no statistically significance in the correlation analysis among distances b,e,angle 1,angle 2,and angle 3(P>20.05).Conclusion:Patients with periarthritis of the shoulder have a smaller distance between the shoulder and humerus,shorter coracoacromial ligaments,and increased compression and friction of the soft tissue beneath them.The vertical stability of the shoulder joint is weakened,and the volume of the subacromial space and rotator cuff space is reduced,which increases the likelihood of rotator cuff injury and shoulder periarthritis.The smaller the distance from the cone-shaped nodule to the outermost end of the clavicle in patients with periarthritis of the shoulder,the closer the coracoacromial ligament is to the cone-shaped ligament,which is prone to exceeding the tensile limit and causing damage.The weakened stability caused by damage to the diagonal ligament may be one of the causes of shoulder periarthritis.The weakening of shoulder joint stability in patients with shoulder periarthritis is a series of chain changes from a single ligament to the core stable area to the shoulder joint.The smaller the area of the core stable area,the greater the stress.

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备注/Memo

备注/Memo:
基金项目:国医大师韦贵康学术思想与临床诊疗传承发展研究中心资助项目(2022V001)
广西中医骨伤科生物力学与损伤修复重点实验室基金资助项目
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更新日期/Last Update: 2024-10-05