変形性肩鎖関節症における画像評価

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In decision making of surgical treatment for painful acromioclavicular (AC) joint osteoarthritis, image evaluation of AC joint is essential. The purpose of this study was to evaluate AC joint by X-ray and MRI images and to introduce new classification of these images. We retrospectively evaluated 40 shoulders of 38 patients (23 male, 15 female), who had arthroscopic distal clavicle resection under the diagnosis of degenerative AC joint osteoarthritis. Average age at the time of surgery was 60.1 years. X-ray images were assessed by the following 3 items: joint space narrowing, osteophyte formation and osteosclerotic change. MRI images were assessed by the following 3 items: joint fluid formation, distal clavicular bony marrow edema and acromional bony marrow edema. Each item was scored 1 point and total assessment was scored 6 points in total based on this new image classification. X-ray images evaluation revealed joint space narrowing in 27 shoulders (67.5%), osteophyte formation in 28 shoulders (70%) and osteosclerotic change in 20 shoulders (50%). MRI images evaluation revealed joint fluid formation in 33 shoulders (82.5%), distal clavicular bony marrow edema in 22 shoulders (55%) and acromional bony marrow edema in 22 shoulders (55%). Average total score was 3.8 points; joint space narrowing, joint fluid formation, distal clavicular bony marrow edema, and acromional bony marrow edema were significantly related to the severity of image evaluation. Our results showed that this new image classification of AC joint is helpful for the severity evaluation of the painful AC joint osteoarthritis.

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