Anatomical Measurement Of Primary Frozen Shoulder In Vivo Based On CTA And Clinic Study

Background:Primary frozen shoulder(adhesive capsulitis)is a common disease in the Department of orthopedics.Many people are involved,the symptoms are heavy,and the life quality of the related people is affected.But at present,its diagnosis is still considered to be a clinical diagnosis It is considered that there is no special performance in imaging examination.Therefore,the subjective index of diagnosis and treatment is too much and the objective index is few,which puzzled the improvement of the level of diagnosis and treatment.With the development of digital reconstruction technology and the understanding of the disease,we gradually found that imaging has certain diagnostic value for primary frozen shoulder.The purpose of this study is to explore the value and role of CT arthrography(CTA)in imaging diagnosis and treatment.Objective:1.CTA was performed to patients with shoulder pain,and the value of CTA in primary frozen shoulder was estimated.The anatomical data of humeral head measured by CT images in vivo were compared with others'cohorts.2.The patients with primary frozen shoulder were treated by non-surgical treatment based on TCM syndrome type.The effect after treatment was observed and the safety and reliability was evaluated.The correlation between clinical results and CTA was studied to explore the role of CTA in clinical grading and prognosis of frozen shoulder.Methods1.By the method of retrieving of relevant literatures,consultation with teachers and experts,the advance in the diagnosis and treatment of primary frozen shoulder was summarized.2.In the outpatient department,65 cases were diagnosed as primary frozen shoulder and CTA was made in our hospital.The following indicators were observed and measured:CHL thickness in oblique sagittal view,width of RI,width of axillary recess and inner and outer wall thickness of axillary recess in oblique coronal view.The CTA images were compared with the CTA images of non frozen shoulder patients and healthy volunteers.The differences in the above indicators were assessed.3.Forty-nine cases of the humeral head were reconstructed by three-dimensional reconstruction software.The related anatomical data were measured:RC,TAS,DAS,TAS/RC ratio,SA,IA,RA,MO and PO.Previous anatomical data was compared and the differences in the above indicators were assessed.4.Sixty-five frozen shoulder patients were divided into three groups based on TCM syndrome type:wind-cold-dampness type,blood stasis type and Qi-blood deficiency type.Relevant data were classified.The correlation between TCM syndrome type,clinical score and CT data was studied.5.Sixty-five frozen shoulder patients were treated by non-surgical treatment.According to different TCM syndrome type,the corresponding Chinese herb was taken orally,and combined with intra-articular injection,external application of Xiaozhong ointment and joint activity exercise.The therapeutic effect and evaluate the safety and effectiveness of the treatment was observed.6.Sixty-two patients who were examined with CTA and followed up were compared with the Pearson correlation analysis of the clinical data(ROM of shoulder and the scores of ASES and VAS)and the CTA data(RI obliteration,width of axillary recess and inner and outer wall thickness of axillary recess).The effect of CTA on the clinical classification and prognosis of primary frozen shoulder was assessed.Results1.The different understanding of primary frozen shoulder in traditional Chinese medicine and Western medicine was systematically expounded,the current diagnosis and treatment progress was understood,and the understanding on the diagnosis and treatment of primary frozen shoulder about traditional Chinese medicine and Western medicine was deepened.2.Compared with the control group,it was found that there was a statistically significant difference in the width of axillary recess and inner and outer wall thickness of axillary recess and the RI obliteration rate.The interobserver reliability was high and the cut-off was 4.5mm(the width of axillary recess),5.6mm(the inner wall thickness),and 5.2mm(outer wall thickness).There was a related diagnostic value.3.The related anatomical data were measured:RC,TAS,DAS,TAS/RC ratio,SA,I A,RA,MO and PO.Compared with the previous literature in volunteers,patients with primary frozen shoulder in the humeral head size were normal.And further study was still need,especially the comparative anatomy data of articular cartilage.Compared with the anatomical data of the western people,there were many differences,suggesting that there is a mismatch between the market prosthesis and our cohort.4.The data of 65 patients showed that wind-cold-dampness type accounted for the largest proportion,and the age and course of disease of Qi-blood deficiency type were larger than those of the other two types;in CT measurement,the inner wall thickness of axillary recess of wind-cold-dampness type was thicker than that of Qi-blood deficiency type;in VAS score,wind-cold-dampness type and blood stasis type were significantly higher than that of Qi-blood deficiency type.It shows that the TCM syndrome type of frozen shoulder is correlated with age,course of disease,CTA data and clinical scoring.5.According to the different TCM syndrome type,three groups of patients were treated by oral Chinese herb,combined with intra-articular injection,external application of Xiaozhong ointment and joint activity exercise.There were significant differences ROM in shoulder passive activity,VAS score and ASES score between after and before treatment.6.62 patients who were examined with CTA and followed up were compared with the Pearson correlation analysis of the clinical data and the CTA data.The correlation of the RI obliteration was weak with the ROM of ertemal rotation and VAS score.The width of axillary recess and inner wall thickness of axillary recess were associated with a lower or moderate degree of shoulder ROM and ASES score.Patients who were re-examined with CTA at followed up showed that the correlation of the width of axillary recess were associated with a lower or moderate degree of shoulder ROM and ASES score.The current study shows that CTA examination is not sufficient to guide clinical classification and predict the prognosis of the disease.Conclusion:1.CTA has certain value in the diagnosis of primary frozen shoulder.It can provide imaging evidence and data of width of axillary recess and inner and outer wall thickness of axillary recess and RI obliteration rate.The interobserver reliability was high and the cut-off was 4.5mm(the width of axillary recess),5.6mm(the inner wall thickness),and 5.2mm(outer wall thickness).There is no change in the size and angle of humeral head in primary frozen shoulder.It suggests that the morphology of humeral head is normal in this disease,but it still needs further research and comparison,especially with articular cartilage.2.TCM syndrome differentiation of frozen shoulder is correlated with age,course of disease,CTA data and clinical scoring index.According to different TCM syndrome type,the corresponding Chinese herb was taken orally,and combined with intra-articular injection,external application of Xiaozhong ointment and joint activity exercise,can achieve good clinical results.According to the clinical data,the correlation of the RI obliteration was weak with the clinical data.The width of axillary recess and inner wall thickness of axillary recess were associated with a lower or moderate degree of clinical data.It shows that CTA examination is not sufficient to guide clinical classification and predict the prognosis of the disease.