解剖因素对中小型肩袖修补术后再撕裂率的预测价值  

Predictive value of shoulder joint anatomical features to the small and medium rotator cuffre-tear rate after rehabilitation

作　　者：苑博 田明[1] 张绍龙 马栋[1] 李玉民[1] 曾俊杰 Yuan Bo;Tian Ming;Zhang Shaolong;Ma Dong;Li Yumin;Zeng Junjie(Department of Orthopaedics,Ciwil Aviation General Hospital,Peking University,Beijing 100123,China)

机构地区：[1]北京大学民航临床医学院(民航总医院)骨科,北京100123

出　　处：《中华骨科杂志》2023年第18期1193-1200,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨肩关节解剖因素与中小型肩袖修补术后再撕裂率的相关性。方法回顾性收集2017年6月至2019年6月民航总医院收治的55例中小型肩袖损伤行单排缝合术患者资料,包括年龄、性别、病程、体质指数、吸烟史、糖尿病史,术后6个月及术后1、2、3年的再撕裂率,术后3年肩关节Constant-Murley评分、加州大学洛杉矶分校肩关节评分(University of California,Los Angeles shoulder scale,UCLASS)以及基于CT测量的临界肩关节角(critical shoulder angle,CSA)、肩峰指数(acromial index,AI)。根据随访过程中是否发生再撕裂将55例分为再撕裂组和未撕裂组。采用单因素方差分析分别比较两组CSA、AI各随访时点差异,采用Fisher精确检验比较两组性别、吸烟史、糖尿病史,采用独立样本t检验比较两组年龄、病程、术后次日CSA、AI、各随访时点UCLA评分、Constant-Murley评分的差异,将术后次日CSA与AI作为术后6个月、1年、2年、3年肩袖再撕裂的易感因素进行二分类变量logistic回归分析。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估术后次日CSA与AI对术后3年再撕裂的预测效能,采用Pearson相关性分析检验CSA、AI与术后功能恢复的相关性。结果55例术后6个月、1年、2年、3年的再撕裂率分别为4%、7%、13%、18%。再撕裂组各随访时点CSA或AI差异均无统计学意义(P>0.05),未撕裂组各随访时点CSA或AI差异均有统计学意义(F=14.16,P<0.001;F=4.64,P<0.001)。术后3年再撕裂组Constant-Murley评分、UCLA评分分别为(93.60±2.84)分、(32.30±1.49)分,未撕裂组分别为(92.11±4.10)分、(33.18±1.27)分,差异无统计学意义(P>0.05)。术后次日CSA是术后1年、2年、3年肩袖再撕裂的危险因素[OR=4.62,95%CI(1.01,21.06),P=0.048;OR=7.071,95%CI(1.52,32.87),P=0.013;OR=3.40,95%CI(1.42,8.12),P=0.006]。术后次日CSA与AI对肩袖修补术后3年再撕裂有一定预测效能,且CSA特异度较AI更高。�Objective To explore the correlation between the anatomical features of shoulder joint and the re-tear rate after surgical repair for small and medium-sized rotator cufftears.MethodsFrom June 2017 to June 2019,55 patients who were diagnosed with small or medium-sized rotator cuff tears and treated with arthroscopic single-row repair were enrolled.Demographics including age,sex,disease course,history of smoking and diabetes mellitus,re-tear rates,Constant-Murley score,University of California,Los Angeles score(UCLA)at 6-month,1-year,2-year and 3-year after operation were collected.Postoperative critical shoulder angle(CSA)and acromial index(AI)were measured and calculated based on CT scan.The patients were divided into two groups:patients who got re-tear history during follow-up were included into endpoint re-tear(ER)group,and those who got no retear history during follow-up were included into endpoint non-tear(EN)group.One-way Anova was used to compare the CSAIAI among different follow-up point.Fisher's exact test was used to compare sex,morbidity of smoking and diabetes between the ER and EN groups.Two independent samples t-test were used to compare age,disease course,CSA and AI at 1-day after operation,functional scores at each follow-up point between the two groups.Binomial logistic regression analysis was performed to test CSA and AI at 1-day after operation as the risk factors of rotator cuff re-tear at 6-month,1-year,2-year and 3-year after operation.The predictive efficacy of CSA and AI at 1-day after operation on re-tear rate at 3-year after operation were evaluated by receiver oper ating characteristic(ROC)curves,Pearson correlation analysis was used to evaluate the correlation between postoperative CSA/AI and postoperative functional recovery.Results The CSA and AI of ER group were insignificantly different among all follow-up point(P>0.05),the CSA and AI of EN group were significantly different among allfollow-up point(F=14.163,P<0.001;F=4.635,P<0.001).The re-tear rates at 6-month,1-year,2-year and 3-y

关 键 词：肩关节 回旋套损伤 回旋套撕裂性关节病 关节镜 再撕裂 

分 类 号：R687.4[医药卫生—骨科学]