摘要目的: 分析影响肩袖全层撕裂(RCT)患者肩肱距离(AHD)变化的相关因素,对比 MRI 与 X 线测量 AHD 的差异,评估术前 AHD 与术后功能恢复的相关性,为临床预后评估及手术策略优化提供依据。方法: 回顾性分析2023年6月至2024年9月收治的64例中大型肩袖全层撕裂患者临床资料。所有患者术前术后均行肩关节MRI和X线正位检查测量AHD。比较MRI与X线测量AHD的差异。根据MRI评估脂肪浸润(Goutallier分级)、冈上肌萎缩(Thomazeau分级)和肌腱断端挛缩程度(Patte分级);术中测量撕裂大小。采用Spearman/Pearson相关性分析判定各因素与术前MRI所测AHD的相关性。所有患者行关节镜下双排缝线桥修复术,术后随访评估Constant-Murley评分并分析其与AHD的相关性。结果: 术前X线测量AHD(7.7±2.3mm)大于MRI测量值(5.8±2.1mm),差异有统计学意义(t=-4.861,P<0.001)。术前MRI所测AHD与撕裂大小(r=-0.836,P<0.001)、症状持续时间(r=-0.715,P<0.001)、脂肪浸润程度(r=-0.623,P<0.001)、肌腱断端挛缩程度(r=-0.572,P<0.001)呈负相关;与冈上肌萎缩(r=0.082,P=0.518)、年龄(r=0.129,P=0.308)、性别(r=-0.052,P=0.683)相关性无统计学意义。术后即刻MRI所测AHD(8.6±1.8mm)较术前增大(t=-30.399,P<0.001),这一结果与创伤性肩袖撕裂关节镜下修复术后肩肱距离变化的研究结果一致。术后临床疗效(Constant-Murley评分)与术后AHD改变的相关性无统计学意义(r=-0.156,P=0.219),但与术前AHD呈正相关(r=0.846,P<0.001)。结论: 使用X线测量的肩肱距离大于MRI的测量值。肩肱距离与多种因素存在相关性,这有助于我们了解肱骨头上移的具体机制。创伤性肩袖撕裂患者行关节镜修复术后肩肱距离较术前会有不同程度的增大。
Abstract：Objective: To analyze factors affecting acromiohumeral distance (AHD) changes in patients with full-thickness rotator cuff tears (RCT) and investigate the correlation between AHD and clinical outcomes after rotator cuff repair. Methods: A retrospective analysis was conducted on 64 patients with medium-to-large full-thickness RCTs treated between June 2019 and September 2020. Preoperative and postoperative AHD measurements were obtained using MRI for detailed assessment and X-ray for the evaluation of the subacromial space. Fat infiltration (Goutallier classification), supraspinatus atrophy (Thomazeau classification), and tendon retraction (Patte classification) were assessed using MRI. Tear size was measured intraoperatively. Spearman/Pearson correlation analyses were used to evaluate the relationships between AHD and variables. All patients underwent arthroscopic double-row suture bridge repair, with postoperative Constant-Murley scores analyzed for correlation with AHD. Results: Preoperative X-ray-measured AHD (7.7±2.3 mm) was significantly larger than MRI measurements (5.8±2.1 mm; t=-4.861, P<0.001). Preoperative MRI AHD showed strong negative correlations with tear size (r=-0.836, P<0.001), symptom duration (r=-0.715, P<0.001), fat infiltration (r=-0.623, P<0.001), and tendon retraction (r=-0.572, P<0.001). The study found no significant correlation between supraspinatus atrophy and rotator cuff tears (r=0.082, P=0.518), nor between age and the incidence of such tears (r=0.129, P=0.308). Additionally, no significant difference was observed in the prevalence of rotator cuff tears between genders (r=-0.052, P=0.683). These findings are consistent with broader research indicating that while age is a risk factor for rotator cuff injuries, the correlation with gender is not as pronounced. Immediate postoperative MRI AHD (8.6±1.8 mm) increased significantly compared to preoperative values (t=-30.399, P<0.001). Postoperative clinical outcomes (Constant-Murley scores) showed no significant correlation with changes in AHD (r=-0.156, P=0.219) but were strongly positively correlated with preoperative AHD (r=0.846, P<0.001). Conclusion: X-ray measurements overestimate AHD compared to MRI. The acromiohumeral distance (AHD) is affected by the extent of the tear, the duration of symptoms, fatty infiltration, and tendon retraction, offering insights into the mechanisms of humeral head migration. Preoperative AHD measurements, as opposed to postoperative changes, are crucial in predicting the outcomes of shoulder surgeries, as evidenced by studies indicating that preoperative AHD can serve as a significant indicator for postoperative shoulder function. a reliable predictor of clinical outcomes after rotator cuff repair.Preoperative radiographic measurement of AHD (7.7±2.3mm) was greater than the MRI measurement (5.8±2.1mm), with a statistically significant difference (t=-4.861, P<0.001). Preoperative MRI-measured AHD correlated negatively with tear size (r=-0.836, P<0.001), duration of symptoms (r=-0.715, P<0.001), degree of fatty infiltration (r=-0.623, P<0.001), and tendon stump contracture (r=-0.572, P<0.001); while showing no statistically significant correlation with supraspinatus muscle atrophy (r=0.082, P=0.518), age (r=0.129, P=0.308), or gender (r=-0.052, P=0.683). Immediate postoperative MRI-measured AHD (8.6±1.8mm) increased compared to preoperative values (t=-30.399, P<0.001), consistent with findings from studies examining changes in acromioclavicular distance following arthroscopic repair of traumatic rotator cuff tears. Postoperative clinical efficacy (Constant-Murley score) showed no statistically significant correlation with postoperative AHD changes (r=-0.156, P=0.219), but exhibited a positive correlation with preoperative AHD (r=0.846, P<0.001).
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2026, Vol. 32 
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