摘要目的:探讨X线数字化断层融合（DTS）成像在冈上肌出口位的肩峰下撞击综合征（SIS）中的诊断价值。方法:回顾性分析2017年7月至2020年1月于巴彦淖尔市医院因肩关节不适就诊，且经临床查体、MRI检查确诊的93例SIS患者的临床资料和影像学资料，其中男性56例、女性37例，年龄30~77(55.4±8.2）岁。所有患者均在MRI检查后7 d内，为明确是否有行肩峰成形术或肩袖重建术的必要而行X线数字化摄影（DR）和DTS成像检查。3种影像学检查方法测量的肩峰形态差异的比较采用非参数秩和检验，肩-肱距离（AHI）的比较采用方差分析，进一步两两比较采用最小显著差异法（LSD）- t检验。采用受试者工作特征（ROC）曲线计算3种影像学检查方法测量的AHI的曲线下面积（AUC）、灵敏度和特异度，AUC的比较采用 Z检验。 结果:MRI、DR、DTS 3种影像学检查方法对SIS患者肩峰形态检查结果的差异无统计学意义（ χ2=2.84， P>0.05）。MRI、DR、DTS 3种影像学检查方法测量SIS患者AHI的差异有统计学意义[（8.37±1.21）mm对（8.91±1.50）mm对（8.66±1.25）mm， F=3.84， P<0.05]，两两比较结果显示，MRI与DR的差异有统计学意义（ t=-2.69， P<0.05），而MRI与DTS、DR与DTS的差异均无统计学意义（ t=-1.60、1.24，均 P>0.05）。MRI、DTS、DR诊断AHI的灵敏度分别为96.35%、96.36%、86.79%，特异度分别为72.44%、58.28%、54.73%，AUC分别为0.906、0.808、0.677，95% CI分别为0.839~0.951、0.727~0.874、0.586~0.760，三者间的差异有统计学意义（ Z=3.01， P<0.05）。 结论:冈上肌出口位DTS是确诊SIS相对经济、实用的影像学检查方法，可以作为肩部不适患者的一种普查方法。

abstractsObjective:To investigate the diagnostic value of X-ray digital tomosynthesis (DTS) imaging in subacromial impingement syndrome (SIS) at supraspinatus exit position.Methods:A retrospective analysis was performed on patients who were admitted to Bayannur Hospital from July 2017 to January 2020. The clinical and imaging data of 93 SIS patients with shoulder joint discomfort who were diagnosed by clinical physical examination and MRI examination were included. The participants included 56 males and 37 females, aged 30-77(55.4±8.2) years. All patients underwent digital radiography (DR) and DTS imaging within 7 days after MRI examination to determine whether acromioplasty or rotator cuff reconstruction was necessary. Nonparametric rank sum test was used to compare the morphological differences of acromion measured by three imaging methods, analysis of variance was used to compare the measured acromio-humeral interval (AHI), and least significant difference (LSD)- t test was used for further pairwise comparison. The area under the curve (AUC), sensitivity and specificity of AHI measured by MRI, DTS and DR were calculated by the receiver operator characteristic (ROC) curve, and the AUCs were compared by Z test. Results:MRI, DR, and DTS imaging methods had no significant difference in the results of acromion morphology examination in SIS patients ( χ2=2.84, P>0.05). In the measurement of AHI in SIS patients, there was significant difference in AHI measured by MRI, DR and DTS ((8.37±1.21) mm vs. (8.91±1.50) mm vs. (8.66±1.25) mm, F=3.84, P<0.05). Pairwise comparison of the differences of AHI measured by three examination methods showed that the differences between MRI and DR were statistically significant ( t=-2.69, P<0.05), but there were no significant difference between MRI and DTS, DR and DTS ( t=-1.60, 1.24; both P>0.05). The sensitivity of MRI, DTS and DR in diagnosing AHI were 96.35%, 96.36% and 86.79% respectively, and the specificity were 72.44%, 58.28% and 54.73% respectively. The AUCs of AHI measured by MRI, DTS and DR were 0.906, 0.808 and 0.677 respectively, the 95% CI were 0.839-0.951, 0.727-0.874 and 0.586-0.760 respectively, and the difference between them was statistically significant ( Z=3.01, P<0.05). Conclusion:Supraspinatus exit position DTS is a relatively economical and practical imaging method for diagnosis of SIS, and it can be used as a screening method for patients with shoulder discomfort.