基于MRI影像学指标及血清学指标构建肩袖损伤修复术后功能转归的列线图模型  

Based on MRI and Serological Indicators,a Nomogram Model of Functional Outcome after Rotator Cuff Repair Was Constructed

作　　者：路支超 孙志强 王新斌 王东 冷德国 LU Zhi-chao;SUN Zhi-qiang;WANG Xin-bin;WANG Dong;LENG De-guo(Department of Pharmacy,Zibo Municipal Hospital,Zibo 255400,Shandong Province,China;Department of Radiology,Zibo Municipal Hospital,Zibo 255400,Shandong Province,China;Department of Blood Transfusion,Zibo Municipal Hospital,Zibo 255400,Shandong Province,China)

机构地区：[1]淄博市市立医院临床药学科 [2]淄博市市立医院放射科 [3]淄博市市立医院输血科,山东淄博255400

出　　处：《中国CT和MRI杂志》2024年第8期138-141,共4页Chinese Journal of CT and MRI

基　　金：山东省医学会临床科研-齐鲁专项(YXH2022ZX02074)。

摘　　要：目的探讨肩袖损伤修复术后功能转归影响因素,并构建列线图模型,为临床决策提供参考信息。方法选取2021年6月~2023年6月我院214例拟行肩袖损伤修复术患者,以术后3个月美国肩肘外科协会评分(ASES)作为功能转归判定标准,分为转归组和非转归组。统计并比较2组一般资料、磁共振(MRI)影像学指标、血清学指标,采用Logistic回归方程分析肩袖损伤修复术后功能转归影响因素,并构建列线图模型,绘制校准曲线、受试者工作特征曲线、决策曲线(DCA)分析列线图模型预测效能及临床适用性。结果两组术后开始功能锻炼时间、术后功能锻炼依从性、SSP回缩距离、关节囊积液、SSP及SSC肌肉脂肪浸润程度分级、FIB、FDP、CRP比较差异有统计学意义(P<0.05);经Logistic回归方程分析,术后开始功能锻炼时间、SSP回缩距离、关节囊积液、SSC肌肉脂肪浸润程度分级、FIB、FDP是肩袖损伤修复术后功能未转归影响因素(P<0.05);参照肩袖损伤修复术后功能转归影响因素构建列线图模型,列线图模型在肩袖损伤修复术后功能转归中的AUC为0.876,95%CI为0.831~0.927,列线图模型表观线和偏差矫正线与理想线偏差不大,在0.10~0.75决策阈值下,列线图模型为临床参与者提供临床获益。结论MRI影像学指标及血清FIB、FDP、CRP对于肩袖损伤修复术后功能转归情况具有较高预测价值,为临床早期预测术后功能转归、制定相应干预方案提供参考。Objective To explore the influencing factors of functional outcome after rotator cuff repair and construct a nomogram model to provide reference information for clinical decision.Methods A total of 214 patients who were to undergo rotator cuff repair in our hospital from June 2021 to June 2023 were selected and divided into the outcome group and the non-outcome group using the American Society for Shoulder-to-elbow Surgery(ASES)as the functional outcome criteria 3 months after surgery.The general data,magnetic resonance(MRI)imaging indicators[degree of joint capsule effusion,tendon retract distance of supraspinatus muscle(SSP),tendon tear degree of subscapular muscle(SSC),tendon tear degree of subaspinatus muscle(ISP)],serological indicators[fibrinogen(FIB),fibrinogen degradation product(FDP),white blood cell count(WBC),C-reactive protein(CRP)]were analyzed and compared between the two groups,Logistic regression equation was used to analyze the influencing factors of functional outcome after rotator cuff injury repair,and a nomogram model was constructed,and calibration curve,subject work characteristic curve,and decision curve(DCA)were drawn to analyze the predictive efficacy and clinical applicability of the nomogram model.Results There were statistically significant differences in the time to start functional exercise,compliance of functional exercise,SSP retraction distance,joint capsule effusion,SSP and SSC muscle fat infiltration degree,FIB,FDP and CRP between the two groups(P<0.05).Logistic regression equation analysis showed that the time to start functional exercise after surgery,SSP retraction distance,joint capsule effusion,SSC muscle fat infiltration grade,FIB and FDP were the factors influencing the functional outcome after rotator cuff injury repair(P<0.05).A nomogram model was constructed with reference to the influencing factors of functional outcome after rotator cuff injury repair.The AUC and 95%CI of the nomogram model in functional outcome after rotator cuff injury repair were 0.876 and 0.831-

关 键 词：肩袖损伤修复术 功能转归 美国肩肘外科协会评分 MRI影像学表现 血清学指标 

分 类 号：R61[医药卫生—外科学]