The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study
The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study
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DOI：
10.1016/j.jse.2017.06.001
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发表时间：
2017-12-01
影响因子：
3
通讯作者：
Barfod, Kristoffer W.
中科院分区：
文献类型：
--
作者：
Bjarnison, Arnar O.;Sorensen, Thomas J.;Barfod, Kristoffer W.
背景：2013年，Moor等人提出了临界肩角(CSA)的概念，并认为CSA异常是肩关节肩袖撕裂(RCT)和骨关节炎(OA)发生的主要因素。这项研究评估了CSA是否与RCT和OA相关，并测试了CSA在测量RCT和OA时的内部和内部可靠性。材料和方法：该研究是一项回顾性病例对照研究。病例分为两组：RCT组97例，OA组87例。对照组按3：1匹配，按年龄和性别，来自795名肱骨骨折患者。按照Moor等人的描述测量CsA。用Logistic回归分析RCT和OA与CSA的关系。模型分别适用于RCT和OA，并使用与各自病例相匹配的对照。结果：随机对照试验组平均CSA为33.9°，匹配对照组为33.6°。CSA>35度的人群发生RCT的优势比为1.12(P=0.63)。骨性关节炎组平均CSA为31.1度，对照组为33.3度。CSA低于30度的人群发生骨性关节炎的优势比为2.25(P=0.002)。CSA测量显示出强大的评分者内和评价者间的可靠性，组内相关系数值高于0.92，最小可检测变化值低于0.4度。结论：本研究没有发现CSA与RCT之间有任何关联，但确实显示出CSA与OA之间的关联，如果患者的CSA低于30度，发生OA的优势比为2.25。结果并不支持建议的做法，即剃除肩峰外侧缘以缩小CSA，因为这可能增加发生OA的风险，而不降低发生RCT的风险。CSA测量显示，评分员内部和之间的可靠性很好。(C)2017年《肩肘外科杂志》董事会。版权所有。
Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of rotator cuff tear (RCT) and osteoarthritis (OA) of the shoulder. This study assessed whether the CSA was associated with RCT and OA and tested the inter-and intrarater reliability of the CSA when measuring RCT and OA.Materials and methods: The study was performed as a retrospective case-control study. The cases comprised 2 groups: 97 patients with RCT and 87 patients with OA. The controls were matched 3: 1, by age and sex, from a population of 795 patients with humeral fractures. The CSA was measured as described by Moor et al. Analysis of the relation with CSA for RCT and OA was done by logistic regression. Models were fitted separately for RCT and OA and used the controls matched to the respective cases. Inter-and intrarater reliability was determined by measuring the intraclass correlation coefficient and minimal detectable change.Results: The mean CSA was 33.9 degrees in the RCT group and 33.6 degrees in the matched control group. The odds ratio for developing RCT for people with a CSA above 35 degrees was 1.12 (P = .63). The mean CSA in the OA group was 31.1 degrees and in the matched control group 33.3 degrees. The odds ratio for developing OA for people with a CSA below 30 degrees was 2.25 (P = .002). The CSA measurements showed strong intra-and inter-rater reliability, with intraclass correlation coefficient values above 0.92 and minimal detectable change values below 0.4 degrees.Conclusions: This study did not find any association between CSA and RCT but did show association between CSA and OA, with a 2.25 odds ratio of developing OA given the patient had a CSA below 30 degrees. The results do not support the suggested praxis of shaving away the lateral border of the acromion to make the CSA smaller because it might increase the risk of developing OA without decreasing the risk of developing RCT. The CSA measurements showed excellent intra-and inter-rater reliability. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.