nchen, Jena, Urban und Fischer, 2002
广州市正骨医院
Guangzhou Orthopedic Hospital
广州市正骨医院
Guangzhou Orthopedic Hospital
Bateman关于肩袖全层撕裂的分级
• Grade 1: cuff tears of 1 cm or less measured in the longest diameter after debriding of the avascular edges（残端清理后撕裂直径小于 1cm）
根据在矢状位撕裂肩袖涉及的肌肉分级 1.肩胛下肌 2.喙肱韧带 3.冈上肌 4.冈上肌+冈下肌（部分） 5.冈上肌+冈下肌（全部） 6.肩胛下肌+喙肱韧带+冈上肌+冈下肌
*Patte, D.: Classification of rotator cuff lesions. Clin Orthop Relat Res, (254): 81±86, 1990
广州市正骨医院
Guangzhou Orthopedic Hospital
临床表现
肩袖损伤会引起肩部疼痛，多为持续性钝痛，可向上 臂或颈部放射，肩外展或伴有内旋和外旋时疼痛加重，
压痛肩峰下的深部，以肱骨大结节处压痛最为明显。 夜间疼痛尤为明显，常常痛醒，患者很难向病侧侧卧。 过顶时疼痛。
广州市正骨医院
裂，剩下很少或者几乎没有肌腱残留）
*Bayne, O., Bateman J. E.: Long term results of surgical repair of full thickness rotator cuff tears. In: Surgery of the shoulder, pp. 167±171. Edited by ateman, J. E.,Welsch, RP. Philadelphia, Saint Louis, Toronto, London, B. C. Decker Inc., The C. V. Mosby Company, 1984
*Ellman H部分肩袖损伤分类（滑囊侧）
• 根据关节镜下肩袖滑囊侧撕裂的深度分级（冠状面） • Grade 1 tear is<3 mm deep（<1/4）. • Grade 2 tear 3–6 mm in depth but <1/2 of the tendonthickness . • Grade 3 tear >6 mm deep(>1/2).
广州市正骨医院
Guangzhou Orthopedic Hospital
肩袖损伤的流行病学
Uhthoff .[1]等在尸体标本中统计肩袖损伤的发病率为20% ， 平均年龄为59.4岁。Lehman .[2]等在尸体标本中统计的发 病率为17%，且30%的病人年龄大于60岁。 Bigliani .[3]等 认为肩袖全层撕裂的发病率在5%-40%之间，且随着老年 化社会的进展，肩袖损伤的发病率将经一步上升。
• Type B : isolated tear within crescent zone. • Type C : tear extending from lateral border of pulley system over medial border of
supraspinatus tendon （冈上肌） up to area of crescent.
*Ellman H. Diagnosis and treatment of incomplete rotator cuff tears.[J]. Clinical Orthopaedics & Related Research, 1990, 254(254):64-74.
广州市正骨医院
Guangzhou Orthopedic Hospital
*Habermeyer P, Magosch P, Lichtenberg S. Classifications and Scores of the Shoulder[M]// Springer, Berlin, 2006.
广州市正骨医院
Guangzhou Orthopedic Hospital
Patte根据矢状位肩袖撕裂涉及的肌肉分级
*Ellman H. Diagnosis and treatment of incomplete rotator cuff tears.[J]. Clinical Orthopaedics & Related Research, 1990, 254(254):64-74.
广州市正骨医院
Guangzhou Orthopedic Hospital
[1] Uhthoff HK, Loehr J, Sarkar K. The pathogenesis of rotator cuff tears. In: Takagishi N, editor. The shoulder. Tokyo: Professional PostGraduate Services;1987: 211-2. [2] Lehman C, Cuomo F, Kummer FJ, Zuckerman JD. The incidence of full thickness rotator cuff tears in a large cadaveric population. Bull Hosp Jt Dis. 1995;54(1):30-1. [3] Bigliani LU, Morrison DS. Relationship between acromial morphology and rotator cuff tears. Orthop Trans. 1986;10:216.
广州市正骨医院
Guangzhou Orthopedic Hospital
Habermeyer根据肩袖在矢状位损伤的部分分级
根据在矢状位以冈上肌两侧为界，将肩袖分为ABC三个 部位，根据撕裂波及的部位分级
Sector A: 撕裂位于前区，包括肩胛下肌、肩袖间 隙及肱二头肌长头腱。
Sector B: 撕裂位于中区，包括冈上肌及两侧。
Sector C: 撕裂位于后区，包括冈下肌及小圆肌。
喙肩韧带
*Habermeyer, P., Lehmann, L:Rotatorenmanschette, Rotatorenintervall und lange Bizepssehne. Edited by Habermeyer P., pp. 333±374. M
广州市正骨医院
Guangzhou Orthopedic Hospital
Patte根据肩袖损伤程度分级
• Group I: partial tears or full-substance tears measuring less than 1 cm in sagittal（矢状位） diameter at bony detachment（止点） a. Deep, partial tears b. Superficial（表面） tears c. Small, full-substance（全层） tears
Hong Kong, London, Munich, Sydney, Tokyo, Lea and Febiger, 1993
广州市正骨医院
Guangzhou Orthopedic Hospital
广州市正骨医院
Guangzhou Orthopedic Hospital
• Grade 2: cuff tears of 1 to 3 cm in diameter after debridement of the avascular edges（残端清理后撕裂直径在1-3cm之间）
• Grade 3: cuff tears of 5 cm or less（撕裂直径在3-5cm之间） • Grade 4: global cuff tears with little or no cuff left（广泛的肩袖撕
广州市正骨医院
Guangzhou Orthopedic Hospital
*Ellman H部分肩袖损伤分类
• 根据关节镜下肩袖关节侧撕裂的深度分级（冠状面） • Grade 1 tear is<3 mm deep(<1/4). • Grade 2 tear 3–6 mm in depth but <1/2 of the tendon thickness . • Grade 3 tear >6 mm deep.
Uhthoff et al.[1] found a 20% prevalence in a series of cadaver dissections in which the mean age of the donors was 59.4 years. Lehman et al.[2] found a prevalence of 17% in a large series of cadaver dissections, with a prevalence of 30% in donors older than sixty years of age. The incidence of fullthickness tears of the rotator cuff ranges from 5% to 40%. Furthermore, epidemiological studies show an increasing frequency of rotator cuff failure with advancing age[3].
肩袖损伤分类
Classifications of Rotator Cuff tears
广州市正骨医院 运动创伤科 张智勉 向孝兵