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The Relationship between the Bony Structure of the Glenohumeral Joint and Rotator Cuff Injury

Author: ZhouJianBo
Tutor: TangKangLai
School: Third Military Medical University
Course: Surgery
Keywords: Shoulder joint Radiologic technology Rotator cuff injury Bony anatomy Measurement and analysis
CLC: R684
Type: Master's thesis
Year: 2011
Downloads: 75
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Abstract

Background rotator cuff injury is one of the main cause of shoulder pain and dysfunction. Rapid progress in the etiology of the rotator cuff injury, including bone structure and soft tissue structures, but what is the impact of a single factor or multi-factor plays a dominant role in the result, or some factor present is not yet completely clear. The start and end points of the rotator cuff are bone, the main function is to lift arm to provide a fulcrum deltoid outreach through the dynamic stability of the humeral head. Rotator cuff to maintain normal relations between the bones, while role by bone, bone structure as an important part of the static force structure, its structure after skeletal maturity exactly whether the rotator cuff injury played a role is not fully understood. Shoulder bone structure and relationship of rotator cuff injury is relatively small, mainly involving the acromion morphology, subacromial space, the angle of inclination of the humeral head and the torsion angle, the glenoid tilt angle and torsion angle aspects and research results is not the same, there is a big controversy, who is more difficult to say because of who fruit. Bone structure is mainly concentrated in the cephalic glenoid side, or the the acromion side of the unilateral structure of measurement, corresponding relationship with the rotator cuff damage relations between the humeral head and glenoid articular match well and acromion has not been reported. Author research team premenstrual experiments to establish a series of multislice CT and subsequent processing technology to measure shoulder bone structure of the standard method, the entity anatomical specimens measurements to verify the accuracy of these methods, and on the part of the shoulder joint bone The structure indicates that the initial measurement and analysis. The purpose of accurate measurement analysis of adult normal shoulder bone structure parameters of measurement and comparative analysis of patients with rotator cuff injury shoulder bone structure indicators. Which further clarify the shoulder bone structure and the rotator cuff of non-traumatic injury, rotator cuff injury factors based on bone structure to supplement and enrich, and shoulder joint disease due to explore new ideas for clinical The choice of treatment to provide a reference. Data collection 100 shoulder joint normal volunteers, 43 male, 57 female sex ratio close to the patient group, the average age of 39.20 years (19 to 60 years old); collected by the MRI diagnosis of a rotator cuff injury, and surgery confirmed clinical cases of rotator cuff injury 46 cases, male 20 cases, 26 females, with an average age of 54.35 years of age (27 to 71 years old) were unilateral rotator cuff supraspinatus tendon injury, patients with no clear trauma and surgical history; use Southwest Hospital, Department of Radiology 16 row multi-slice spiral CT (Siemens, Germany) scanning and data processing. 100 normal volunteers (normal group) and 46 patients (patient group) after 16-slice spiral CT scan bilateral shoulder joint, all scanned data directly imported CT LEONARDO workstation using the workstation comes with image processing tools and measurement tools for image processing and data measurement. Measurement indicators include the humeral head torsion angle, tilt angle, the radius of curvature of the coronal, axial curvature radius, head nodules center distance and head nodules elevation angle; scapular glenoid corner, tilt angle, the radius of curvature of the coronal, axial curvature radius, the coronal the inclusive angle and shaft bit inclusive angle; calculated the measuring head glenoid match indicators including the head the glenoid fitting index, inclusive index, head glenoid offset upward, inward offset head glenoid; Other indicators including head acromion distance, nodules acromion distance from the acromion coracoid. All measure data using SPSS 13.0 compared statistical analysis. 1 normal group shoulder all the parameters of the left and right side comparative analysis between the left and right side were not statistically different, p value gt; 0.05 2. The patients group all parameters of Kin ipsilateral comparative analysis, the humeral head knot section elevation angle, the angle of inclination of the glenoid and humeral head acromion distance the three indicators Kin ipsilateral statistically significant p value lt; 0.05. The the glenoid tilt angle ipsilateral average 1.3 degrees more than the contralateral, ipsilateral glenoid tilt upwards; humeral head nodules average elevation angle ipsilateral than contralateral 1.6 degrees tilt between the affected side of the head and the greater tuberosity greater degree; humeral head acromion away from the affected side than the contralateral small 0.04cm small gap between the ipsilateral humeral head and the acromion. The normal group and the patient group parameter indicators through comparative statistical analysis, the humeral head nodules elevation angle normal group and the group of patients affected side there is a significant difference between a p-value lt; 0.05 the affected side of the patient group an average of 2.1 degrees greater than the normal group, and normal group and the patient group contralateral comparison was not statistically significant p-value gt; 0.05; glenoid axial curvature radius of the normal group, with the group of patients there is a significant statistical difference p-value lt; 0.05, the patient group than the normal group, the average small 0.8cm ; axial included angle of the normal group and the group of patients there is a significant statistical difference p-value lt; 0.05, the patient group than the normal group, the average is 6 degrees; the glenoid tilt angle the group affected side in patients with normal contrast exists significant difference p the value lt; 0.05, the group of patients affected side than the normal group average is 1.1 degrees, the patient group contralateral normal group comparison was not statistically significant p-value gt; 0.05; axial Chimeric index and axial inclusive index normal group and patients there is a significant difference between group comparison p-value lt; 0.05, two-phase indicators related to the glenoid curvature radius and inclusive angle; between head acromion from patients' groups and health ipsilateral normal group were statistically significant p-value lt ; 0.05, the patient group contralateral and ipsilateral respectively, compared with the normal group average 0.06cm and 0.1cm, the patient group with bilateral humeral head to the acromion distance than the normal group that subacromial small gap. Data between relevant indicators: humeral head axial curvature radius of the curvature of the coronal radius nodules head the center there is a positive correlation between the distance and head of coronal and axial curvature radius; glenoid axis bit song degree radius tolerant the angle and inclusive index is negatively correlated with the axial, axial Chimeric index and inclusive index positive correlation. Conclusion 1. Accurate measurement analysis the adult normal shoulder joint bone structure of some indicators, some indicators measuring the literature has not been reported, especially the reaction of the indicators of the overall structure of the shoulder joint; some indicators do to improve the methods of measurement, provide more accurate data reference to the relevant section of shoulder bone structure of the shoulder joint disease. 2 The study found the glenoid tilt angle ipsilateral than contralateral, the glenoid upward tilt angle of the size of the rotator cuff injury, when prompted degree of glenoid upward tilt rotator cuff may be easier to damage; head nodules the elevation angle ipsilateral than the contralateral side, and larger than the normal control group, between the humeral head and greater tuberosity tilt rotator cuff injury; overhead acromion away from the affected side is less than the contralateral, while the patient group with bilateral were less than the normal control group, head glenoid upward offset distance Kin ipsilateral contrast no difference, so the patient group, there may be low acromion, low acromion may cause damage to the rotator cuff. 3. Glenoid morphology rival glenoid matching affect large explore head glenoid match especially with the shoulder joint disease should be more concerned about the glenoid morphology.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Joint disease and injury
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