Korakoakromial ligament morfolojisinin skapula morfolojisi ve sık görülen omuz patolojileri ile ilişkilerinin değerlendirilmesi
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Lteratüre bakıldığında omuz patolojlernde krtk omuz açısı (CSA), glenod versyon (GV), glenod
nklnasyon (Gİ), korakoakromal lgament (KAL) kalınlık, korakoakromal ark açısı gb parametreler ve omuz
patolojler lşkler araştırılmıştır. Bu çalışmanın amacı KAL uzunluğunu ve blnen bu ölçümlere ek olarak kend
tanımladığımız radyolojk ölçümlerden de yararlanarak KAL ve skapula morfolojsnn omuz patolojler
üzerndek etksn ortaya koymaktır.
Yöntem: Bu çalışmada Aralık 2016- Aralık 2023 tarhler arasında Necmettn Erbakan Ünverstes Meram Tıp
Fakültes ortoped ve travmatoloj polklnğne omuz ağrısı le başvuran 950 hasta çersnden dışlama krterler
kullanarak (ler derece artroz olması,brden çok omuz patolojsnn br arada olması ) rastgele seçlen 213 hasta
dahl edld. Çalışma grubunda anteror omuz nstabltes, subakromyal sıkışma sendromu, rotator manşet yırtığı
grupları olarak hepsnden 50 şer hasta rastgele seçld. Kontrol grubu manyetk rezonans (MR) görüntülemede
(herhang br omuz patolojs olmayan) normal grup 63 hasta rastgele seçld. Çalışma ve kontrol grubu hastalarının
MR ve röntgen kestlernde; daha önceden tanımlanmış olan CSA, GV, Gİ, korakoakromyal ark açısı, bunlara ek
olarak KAL uzunluğu ve bzm yen tanımladığımız akromyon kapsama açısı (AKA), korakoakromyal kapsama
açısı (KKA), akromon-glenod aks arası açı farkı (AGAF) ölçümler kullanıldı.
Bulgular: Çalışmaya dahl edlen toplam 213 hastanın 90’ı kadın (%42,2), 123’ü erkekt (%57,8). Çalışmaya
dahl edlen breylern kontrol grubu, rotator manşet yırtığı, zole subakromyal sıkışma, anteror omuz nstabltes
olanların 118’nde (%55,5) sağ kolda ken, 95’nde (%44,5) sol koldaydı. Korakoakromyal ark açısı, KAL total
uzunluğu, KAL yükseklk ve aksyel uzunluk AGAF, KKA, GV, CSA gruplar arası (p<0,001) bu parametreler le
patolojler arasında anlamlı farklılıklar olduğunu tespt edld. Ölçümlerde gruplar arasında subakromal sıkışma
sendromu çn CSA, GV, AGAF, KKA parametrelernde anlamlı farklılıklar olduğu gözlend.(p<0,001) Rotator
manşet yırtığı grubunda se; AGAF, KKA, KAL aksyel uzunluk, KAL yükseklk, KAL total uzunluk, KAA
parametrelernde anlamlı farklılıklar olduğu gözlend.(p<0,001) Anteror omuz nstablte grubunda se; AGAF,
KKA, KAL aksyel uzunluk, KAL total uzunluk, KAA parametrelernde anlamlı farklılıklar olduğu
gözlend.(p<0,001) KAL aksyel uzunluk, yükseklk ve total uzunluğu (sırasıyla 44,2 mm,14 mm,47 mm eşk
değer ve üzernde), rotator manşet yırtığı tanısında anlamlı farklılıklar gösterdğ tespt edld.(sırasıyla p değerler;
p=0,005, <0,001, <0,001) KAL aksiyel uzunluk, KAL total uzunluk(sırasıyla 43,8 mm, 47,6 mm ve eşik değer ve
üzerinde ) ve korakoakromial ark açısının ise (123,8 derece eşik değer ve üzeri açılarda) instabilite tanısında
anlamlı farklılıklar gösterdiği tespit edildi.(sırasıyla p değerleri ; <0,001 , <0,001, 0,001)Bizim tanımladığımız
açılardan korakoakromial kapsama açısının (53,1 derece eşik değer ve üzerinde) instabilite tanısında anlamlı
farklılıklar gösterdiği tespit edildi.(p=0,011) CSA’nın ve GV’nin (sırasıyla 30,1 ve 2 derece eşik değer)
subakromiyal sıkışma sendromu tanısında anlamlı farklılıklar gösterdiği tespit edildi.(sırasıyla p<0,03, p<0,001)
Sonuç: Sonuç olarak radyolojk ölçümlerle blg sahb olunan skapula morfolojs; KAL aksyel ve total
uzunluğunun artması le nstablte ve rotator manşet yırtığı rsknn arttığı gözlend. Korakoakromyal ark açısı ve
bzm tanımladığımız korakoakromal kapsama açısının artması le nstablte rsknn arttığı gözlend. Bunlara ek
olarak CSA ve GV’nn subakromal sıkışma sendromu le lşkl parametreler olableceğ tespt edld. KAL ve
skapula morfolojlernn sık görülen omuz patolojlernn etyopatogeneznn aydınlatılmasına yardımcı
parametreler olduğu gözlend.
Purpose: Taking a look at the literature, parameters such as CSA, GV, GI, CAL thickness, coracoacromial arc angle and their relationships with radiological measurements have been investigated in shoulder pathologies. The purpose of this study is to reveal the effect of radiological measurements on the etiopathogenesis of shoulder pathologies by adding our own defined radiological measurements in addition to these known measurements. Method: Included in this study are 213 patients who were randomly selected from 950 patients who presented to the relevant departments of Necmettin Erbakan University Meram Medical Faculty with shoulder pain between December 2010 and December 2023, using exclusion criteria (advanced arthrosis, coexistence of more than one shoulder pathology). In the study group, 50 patients each with instability, isolated subacromial impingement, and isolated Bankart lesion were randomly selected. In the control group, 63 patients with normal MRI (without any shoulder pathology) were randomly selected. In the x ray and MRI scans of the patients in the study and control groups, we made use of the previously defined CSA, GV, GI, coracoacromial arc angle and CAL length, as well as the measurements we defined, namely the ac coverage angle, CAL coverage angle and angle difference between the acromion-glenoid axis. Findings: Of the total 213 patients included in the study, 90 were females (42.2%) and 123 were males (57.8%). In the control group, 118 (55.5%) of those with rotator cuff pathology, isolated subacromial impingement, and Bankart lesion were on the right arm, while 95 (44.5%) of patients had them on the left arm. In between the groups a significant difference was found between the parameters coracoacromial arch angle, CAL total length, CAL height and axial length AGAF, CCA, GV, CSA and the pathologies (p<0.001). In the measurements, it was observed that there were significant differences in the CSA, GV, AGAF, KKA parameters for subacromial impingement syndrome between the groups (p <0.001). In the rotator cuff tear group, it was observed that there was significant difference between the parameters AGAF, CCA, CAL axial length, CAL height, CAL total length and CAL (p<0.001). In the anterior shoulder instability group, it was observed that there was significant difference between the parameters AGAF, CCA, CAL axial length, CAL total length and CAL (p<0.001). It was discovered that CAL axial length, height and total length showed significant difference in the diagnosis of rotator cuff tears (threshold value of 44.2 mm, 14 mm, 47 mm and above, respectively) (p values; p=0.005, <0.001, <0.001, respectively). It was determined that CAL axial length, CAL total length (threshold value of 43.8 mm, 47.6 mm and above, respectively) and the coracoacromial arch angle (at threshold angles of 123.8 degrees and above) showed significant differences in the diagnosis of instability (p values; <0.001, <0.001, 0.001, respectively). From the angles we defined, the coracoacromial coverage angle (threshold value of 53.1 degrees and above) showed significant difference in the diagnosis of instability (p=0.011). It was determined that CSA and GV (threshold value of 30.1 and 2 degrees, respectively) showed significant differences in the diagnosis of subacromial impingement syndrome. (p<0.03, p<0.001, respectively) Conclusion: Consequently, it was determined that the risk of instability and rotator cuff tear increased with increasing CAL axial and total length, which are related to scapular morphology and whose information are obtained via radiological measurements, which is informed by radiological measurements; it was observed that the risk of instability increased as the coracoacromial arch angle and the coracoacromial coverage angle we defined increased. In addition, it was determined that CSA and GV could be useful parameters in subacromial impingement syndrome. It was observed that CAL and scapular morphologies were useful parameters that helped elucidate the etiopathogenesis of common shoulder pathologies.
Purpose: Taking a look at the literature, parameters such as CSA, GV, GI, CAL thickness, coracoacromial arc angle and their relationships with radiological measurements have been investigated in shoulder pathologies. The purpose of this study is to reveal the effect of radiological measurements on the etiopathogenesis of shoulder pathologies by adding our own defined radiological measurements in addition to these known measurements. Method: Included in this study are 213 patients who were randomly selected from 950 patients who presented to the relevant departments of Necmettin Erbakan University Meram Medical Faculty with shoulder pain between December 2010 and December 2023, using exclusion criteria (advanced arthrosis, coexistence of more than one shoulder pathology). In the study group, 50 patients each with instability, isolated subacromial impingement, and isolated Bankart lesion were randomly selected. In the control group, 63 patients with normal MRI (without any shoulder pathology) were randomly selected. In the x ray and MRI scans of the patients in the study and control groups, we made use of the previously defined CSA, GV, GI, coracoacromial arc angle and CAL length, as well as the measurements we defined, namely the ac coverage angle, CAL coverage angle and angle difference between the acromion-glenoid axis. Findings: Of the total 213 patients included in the study, 90 were females (42.2%) and 123 were males (57.8%). In the control group, 118 (55.5%) of those with rotator cuff pathology, isolated subacromial impingement, and Bankart lesion were on the right arm, while 95 (44.5%) of patients had them on the left arm. In between the groups a significant difference was found between the parameters coracoacromial arch angle, CAL total length, CAL height and axial length AGAF, CCA, GV, CSA and the pathologies (p<0.001). In the measurements, it was observed that there were significant differences in the CSA, GV, AGAF, KKA parameters for subacromial impingement syndrome between the groups (p <0.001). In the rotator cuff tear group, it was observed that there was significant difference between the parameters AGAF, CCA, CAL axial length, CAL height, CAL total length and CAL (p<0.001). In the anterior shoulder instability group, it was observed that there was significant difference between the parameters AGAF, CCA, CAL axial length, CAL total length and CAL (p<0.001). It was discovered that CAL axial length, height and total length showed significant difference in the diagnosis of rotator cuff tears (threshold value of 44.2 mm, 14 mm, 47 mm and above, respectively) (p values; p=0.005, <0.001, <0.001, respectively). It was determined that CAL axial length, CAL total length (threshold value of 43.8 mm, 47.6 mm and above, respectively) and the coracoacromial arch angle (at threshold angles of 123.8 degrees and above) showed significant differences in the diagnosis of instability (p values; <0.001, <0.001, 0.001, respectively). From the angles we defined, the coracoacromial coverage angle (threshold value of 53.1 degrees and above) showed significant difference in the diagnosis of instability (p=0.011). It was determined that CSA and GV (threshold value of 30.1 and 2 degrees, respectively) showed significant differences in the diagnosis of subacromial impingement syndrome. (p<0.03, p<0.001, respectively) Conclusion: Consequently, it was determined that the risk of instability and rotator cuff tear increased with increasing CAL axial and total length, which are related to scapular morphology and whose information are obtained via radiological measurements, which is informed by radiological measurements; it was observed that the risk of instability increased as the coracoacromial arch angle and the coracoacromial coverage angle we defined increased. In addition, it was determined that CSA and GV could be useful parameters in subacromial impingement syndrome. It was observed that CAL and scapular morphologies were useful parameters that helped elucidate the etiopathogenesis of common shoulder pathologies.
Açıklama
Anahtar Kelimeler
Korakoakromal lgament, Coracoacromial ligament, subakromal sıkışma sendromu, subacromial impingement syndrome, skapula morfolojs, scapula morphology
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özdemirci, A. (2024). Korakoakromial ligament morfolojisinin skapula morfolojisi ve sık görülen omuz patolojileri ile ilişkilerinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
