肩袖损伤保守治疗失败的危险因素分析  

Risk factors for failure of conservative treatment of rotator cuff injury

作　　者：张清[1] 向明[1] 李一平[1] 陈杭[1] 胡晓川[1] 杨金松 Zhang Qing;Xiang Ming;LiYiping;Chen Hang;Hu Xiaochuan;Yang Jinsong(Department of Upper Limb,Sichuan Provincial Orthpaedics Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院上肢科,成都610041

出　　处：《中华肩肘外科电子杂志》2022年第2期129-134,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：四川省干部保健科研课题(川干研2019-601)。

摘　　要：目的分析肩袖损伤行保守治疗失败的危险因素,为肩袖损伤行保守治疗及手术治疗时机提供依据。方法本次实验对具有肩痛症状的肩袖损伤患者通过纳入及排除标准,前瞻性地选择中小型肩袖损伤患者行保守治疗,记录患者一般情况、影像学表现、功能评分等。通过至少6个月的保守治疗,并进行随访,记录分析肩袖损伤行保守治疗失败或病变进展的危险因素。结果共120例患者纳入研究,通过至少6个月的保守治疗,75例(62.5%)患者症状消失或明显缓解,45例(37.5%)患者保守治疗失败行手术治疗。单因素分析显示创伤史、工伤及车祸史、BMI高、初始Constant评分低、初始美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)低这几个指标有阳性意义(P<0.005),是保守治疗失败的危险因素;病史时长、吸烟、饮酒不影响保守治疗的结局。Logistic多因素分析显示疼痛程度、肩峰3型、CSA≥35°、脂肪浸润分级高、撕裂长度、撕裂宽度为保守治疗失败的危险因素(P<0.005);性别、年龄、Cofield分型、全层或部分撕裂、撕裂深度不影响保守治疗的结局。结论众多因素可能影响保守治疗的最终结局,在这些因素中,创伤史、工伤及车祸史、BMI高、初始Constant评分低、初始ASES评分低、疼痛程度、肩峰3型、CSA≥35°、脂肪浸润分级高、撕裂长度、撕裂宽度是保守治疗的危险因素,所以在给患者制定治疗方案时需考虑这方面因素。Background Optimal patient selection is key to the success of conservative treatment for rotator cuff tears.The factors associated with pain and loss of function in patients with rotator cuff tears are unclear.Objective To record and analyze the risk factors for failure of conservative treatment or progression of rotator cuff injury and to provide the basis for conservative treatment and surgical treatment of rotator cuff injury.Methods In this study,patients with rotator cuff injury were selected for conservative treatment through inclusion and exclusion criteria.The patients'general conditions,imaging,and functional scores were recorded.The risk factors for conservative treatment failure or rotator cuff injury progression were recorded and analyzed by conservative treatment and follow-up.Results A total of 120 patients were included in this study.Univariate analysis showed that trauma history,industrial injury and traffic accident history,high BMI,low initial Constant score,and low initial ASES score had positive significance and were risk factors for conservative treatment failure.Medical history length,smoking,and alcohol consumption did not affect the outcome of conservative treatment.Logistic multivariate analysis showed that pain degree,acromial type 3,CSA≥35°,high grade of fat infiltration,tear length,and tear width were the risk factors for conservative treatment failure.Gender,age,Cofield classification,full-thickness or partial tear,and tear depth did not affect the outcome of conservative treatment.Conclusion Many factors may affect the outcome of conservative treatment.Among these factors,history of trauma,history of industrial injury and traffic accident,high BMI,low initial Constant score,low initial ASES score,pain degree,acromial type 3,CSA≥35°,high grade of fat infiltration,tear length and tear width is considered to lead to poor conservative treatment outcome.These factors should be taken into account when making treatment plans for patients.

关 键 词：肩袖损伤 保守治疗 失败 危险因素 

分 类 号：R687.4[医药卫生—骨科学]