肩袖损伤修复术后再撕裂的相关因素与预测
作者:
作者单位:

1.常州市第一人民医院骨关节科,江苏常州 213000 ;2.常州市第七人民医院骨科,江苏常州 213000

作者简介:

于万涛,主治医师,研究方向:骨关节,(电子信箱)13776893684@163.com

中图分类号:

R687

基金项目:

江苏省自然科学基金(编号:BK20201153)


Risk factors and prediction of rotator cuff re-tear after arthroscopic repair
Author:
Affiliation:

1.Department ofOrthopaedic and Joint Surgery, First People's Hospital of Changzhou City, Changzhou 213000 , Jiangsu, China ; 2.Department of Orthope⁃dics, Seventh People's Hospital of Changzhou City, Changzhou 213000 , Jiangsu, China

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    摘要:

    [目的]探讨肩袖损伤修复术后再撕裂的相关因素并建立和验证预测模型。[方法]前瞻性选取2019年1月—2022 年10月本院收治的92例巨大肩袖撕裂患者为研究对象,均给予巨大肩袖撕裂修复术,观察术后12个月内再撕裂情况。采用单因素比较和逻辑回归分析探索再撕裂的相关因素,建立术后再撕裂的预测模型并进行模型的验证及效能评估。[结果]92例中,21例患者确认为术后再撕裂,占比22.8%。单因素比较显示,再撕裂组的撕裂长度[(4.1±0.6)cmvs(3.5±0.4)cm,P<0.001]、肌腱回缩程度[I/II/III,(7/10/4)vs(49/20/2),P=0.003]、肩袖脂肪浸润程度[I/II/III,(10/8/3)vs(41/29/1),P=0.039]均显著大于愈合组,但是前者的肩峰肱骨头间距[(3.7±0.3)mmvs(4.1±0.4)mm,P<0.001]、肌腱修复质量[1/2,(13/8)vs(59/12),P=0.039]显著低于愈合组。 逻辑回归结果显示,肌腱修复质量差(OR=5.333,P<0.001)、肩峰肱骨头间距小(OR=5.145,P<0.001)、肌腱回缩程度重(OR= 4.707,P<0.001)、撕裂长度大(OR=4.384,P<0.001)是术后再撕裂的危险因素。列线图预测模型结果显示,C-index指数为0.809 (95%CI0.763~0.841),预测巨大肩袖撕裂修复术后再撕裂的校正曲线趋近于理想曲线(P>0.05)。ROC曲线结果显示:列线图模型预测术后再撕裂的灵敏度81.0%,特异度为84.5%,AUC为0.856(95%CI0.776~0.939)。[结论]撕裂长度、肌腱回缩程度、 肩峰肱骨头间距、肌腱修复质量是术后再撕裂的危险因素,列线图模型预测巨大肩袖撕裂修复术后再撕裂风险效能良好。

    Abstract:

    [Objective] To search the related factors of rotator cuff retear after repair and establish and verify the prediction model.[Methods] A total of 92 patients with large rotator cuff tear admitted to our hospital from January 2019 to October 2022 were selected as theresearch subject, all of whom were given the large rotator cuff tear repair, and the re-tear was observed within 12 months after surgery. Uni-variate comparison and logistic regression analysis were used to explore the factors related to retear, and the prediction model of retear aftersurgery was established and validated. [Results] Of the 92 patients, 21 were confirmed as postoperative rotator cuff retear, accounting for22.8%. As for univariate comparison, the re-tear group proved significantly greater than the healed group in terms of primary tear length[(4.1±0.6) cm vs (3.5±0.4) cm, P<0.001], the degree of tendon retraction [I/II/III, (7/10/4) vs (2/49/20), P=0.003], the degree of rotator cuff fatinfiltration [I/II/III, (10/8/3) vs (41/29/1), P=0.039], while the former was significantly less than the latter in terms of the acromiohumeral dis-tance (AHD) [(3.7±0.3) mm vs (4.1±0.4) mm, P<0.001], and tendon repair quality [1/2, (13/8) vs (59/12), P=0.039]. As results of logistic re-gression, poor tendon repair quality (OR=5.333, P<0.001), less AHD (OR=5.145, P<0.001), greater tendon retraction degree (OR=4.707, P<0.001), longer tear length (OR=4.384, P<0.001) were the risk factors for postoperative re-tear. The results of the nomogram prediction modelshowed that the C-index index was 0.809 (95%CI 0.763~0.841), and the correction curve for predicting retear after repair of giant rotatorcuff tear was close to the ideal curve (P>0.05). ROC curve results showed that the sensitivity, specificity and area under curve (AUC) of thenomogram model for predicting postoperative retear were 81.0%, 84.5%, and 0.856 (95%CI 0.776~0.939). [Conclusion] Tear length, ten-don retraction degree, acromiohumeral distance and tendon repair quality are risk factors for postoperative retear, and the nomogram modelis effective in predicting the risk of retear after repair of giant rotator cuff tear.

    参考文献
    [1] Plancher KD,Shanmugam J,Briggs K,et al.Diagnosis and management of partial thickness rotator cuff tears:a comprehensive review [J].J Am Acad Orthop Surg,2021,29(24):1031-1043.DOI:10.5435/JAAOS-D-20-01092.
    [2] 刘震,王晗,王晓光,等.镜下"中国结"修复冈上肌腱腹交界区撕裂[J].中国矫形外科杂志,2022,30(8):745-748.DOI:10.3977/j.issn.1005-8478.2022.08.15.Liu Z,Wang H,Wang XG,et al."Chinese knot" for arthroscopic repair of supraspinatus tear in muscle-tendon junction [J].Orthopedic Journal of China,2022,30(8):745-748.DOI:1005-8478.2022.08.15.
    [3] 苏超,刘伟杰,唐航,等.镜下“8”字双排无结锚钉修复巨大肩袖撕裂[J].中国矫形外科杂志,2022,30(24):2270-2273.DOI:10.3977/j.issn.1005-8478.2022.24.13.Su C,Liu WJ,Tang H,et al.Arthroscopic figure 8 double-row knotless anchors for massive rotator cuff tears [J].Orthopedic Journal of China,2022,30(24):2273-2273.DOI:1005-8478.2022.24.13.
    [4] Misir A,Uzun E,Kizkapan TB,et al.Factors associated with the development of early-to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair [J].J Shoulder Elbow Surg,2021,30(7):1572-1580.DOI:10.1016/j.jse.2020.09.016.
    [5] ZhaoJ,Luo M,Pan J,et al.Risk factors affecting rotator cuff retear after arthroscopic repair:a meta-analysis and systematic review [J].J Shoulder Elbow Surg,2021,30(11):2660-2670.DOI:10.1016/j.jse.2021.05.010.
    [6] Kim H,Kim DM,Kholinne E,et al.Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair [J].J Shoulder Elbow Surg,2022,31(2):310-317.DOI:10.1016/j.jse.2021.07.012.
    [7] Routledge JC,Saber AY,Pennington N,et al.Re-tear rates following rotator cuff repair surgery [J].Cureus,2023,15(1):34426 34430.DOI:10.7759/cureus.34426.
    [8] Shah NS,Suriel Peguero E,Umeda Y,et al.Long-term outcomes of massive rotator cuff tear repair:a systematic review [J].HSS J,2022,18(1):130-137.DOI:10.1177/15563316211008137.
    [9] Huang X,Luo Z,Liang W,et al.Survival nomogram for young breast cancer patients based on the SEER database and an external validation cohort [J].Ann Surg Oncol,2022,29(9):5772 5781.DOI:10.1245/s10434-022-11911-8.
    [10] Li Y,Chen D,Xuan H,et al.Construction and validation of prognostic nomogram for metaplastic breast cancer [J].Bosn J Basic Med Sci,2022,22(1):131-139.DOI:10.17305/bjbms.2021.5911.
    [11] Doiron-Cadrin P,Lafrance S,Saulnier M,et al.Shoulder rotator cuff disorders:a systematic review of clinical practice guidelines and semantic analyses of recommendations [J].Arch Phys Med Rehabil,2020,101(7):1233-1242.DOI:10.1016/j.apmr.
    [12] Baumgarten KM,Barthman BJ,Chang PS.The American shoulder and elbow score is highly correlated with the Western Ontario Rotator Cuff Index and has less responder and administrator burden [J].Arthrosc Sports Med Rehabil,2021,3(6):1637-1643.DOI:10.1016/j.asmr.
    [13] Guo S,Zhu Y,Song G,et al.Assessment of tendon retraction in large to massive rotator cuff tears:a modified PATTE classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability [J].Arthroscopy,2020,36(11):2822-2830.DOI:10.1016/j.arthro.2020.06.023.
    [14] Wallenberg RB,Belzer ML,Ramsey DC,et al.MRI-based 3-dimensional volumetric assessment of fatty infiltration and muscle atrophy in rotator cuff tears [J].J Shoulder Elbow Surg,2022,31(6):1272-1281.DOI:10.1016/j.jse.2021.12.037.
    [15] 郭斯翊,朱以明,鲁谊,等.大型及巨大肩袖撕裂修复的不可修复性与术后再撕裂的危险因素研究[J].中国运动医学杂志,2022,41(9):665-673.DOI:10.3969/j.issn.1000-6710.2022.09.001.Guo SY,Zhu YM,Lu Y,et al.The risk factors of irreparability and retear of large to massive rotator cuff repairs [J].Chinese Journal of Sports Medicine,2022,41(9):665-6773.DOI:10.3969/j.issn.1000-6710.2022.09.001.
    [16] 高玉镭,管士伟,李大河,等.镜下单排锚钉修复大型肩袖撕裂的近期效果[J].中国矫形外科杂志,2022,30(24):2285-2288.DOI:10.3977/j.issn.1005-8478.2022.24.17.Gao YL,Guan SW,Li DH,et al.The recent effects of intrascopic repair of large rotator cuff tears with a single line anchor [J].Orthopedic Journal of China,2022,30(24):2285-2288.DOI:1005 8478.2022.24.17.
    [17] Lapner P,Henry P,Athwal GS,et al.Treatment of rotator cuff tears:a systematic review and meta-analysis [J].J Shoulder Elbow Surg,2022,31(3):120-129.DOI:10.1016/j.jse.2021.11.002.
    [18] Kucirek NK,Hung NJ,Wong SE.Treatment options for massive irreparable rotator cuff tears [J].Curr Rev Musculoskelet Med,2021,14(5):304-315.DOI:10.1007/s12178-021-09714-7.
    [19] Itoigawa Y,Yoshida K,Nojiri H,et al.Association of recurrent tear after arthroscopic rotator cuff repair and superoxide-induced oxidative stress [J].Am J Sports Med,2021,49(8):2048-2055.DOI:10.1177/03635465211014856.
    [20] 郭斯翊,朱以明,鲁谊,等.止点内移修复大型及巨大肩袖撕裂临床与影像学随访研究[J].中国修复重建外科杂志,2023,37(4):391-397.DOI:10.7507/1002-1892.202212019.Guo SY,Zhu YM,Lu Y,et al.Clinical and imaging follow-up study of repair of large and giant rotator cuff tears with inward stop [J].Chinese Journal of Reparative and Reconstructive Surgery,2019,37(4):391-397.DOI:10.7507/1002-1892.202212019.
    [21] 陈俊,楼珏翔,申屠国建,等.肩关节峰盂角对肩袖撕裂修补术后再撕裂的影响[J].中国运动医学杂志,2022,41(6):423 429.DOI:10.3969/j.issn.1000-6710.2022.06.002.Chen J,Lou JX,Shentu GJ,et al.The correlation between CSA and retear rate after arthroscopic rotator cuff repair [J].Chinese Journal of Sports Medicine,2019,41(6):423-429.DOI:10.3969/j.issn.1000-6710.2022.06.002.
    [22] Longo UG,Carnevale A,Piergentili I,et al.Retear rates after rotator cuff surgery:a systematic review and meta-analysis [J].BMC Musculoskelet Disord,2021,22(1):749-752.DOI:10.1186/s12891-021-04634-6.
    [23] 赵加全,向飞帆,曾维君,等.肩袖修复术后再次撕裂的危险因素分析[J].解放军医学院学报,2022,43(11):1156-1159,1169.DOI:10.3969/j.issn.2095-5227.2022.11.010.Zhao JQ,Xiang FF,Zeng WJ,et al.Factors associated with retear after rotator cuff repair [J].Academic Journal of Chinese PLA Medical School,2012,43(11):1156-1159,1169.DOI:10.3969/j.issn.2095-5227.2022.11.010.
    [24] Lobo-Escolar L,Ramazzini-Castro R,Codina-Gra?ó D,et al.Risk factors for symptomatic retears after arthroscopic repair of full-thickness rotator cuff tears [J].J Shoulder Elbow Surg,2021,30(1):27-33.DOI:10.1016/j.jse.2020.05.010.
    [25] 田晟源,徐子航,张强,等.基于文献的肩袖撕裂初次修补术后再发撕裂影响因素分析[J].山东医药,2021,61(33):66-70.DOI:10.3969/j.issn.1002-266X.2021.33.016.Tian SY,Xu ZH,Zhang Q,et al.Analysis of influencing factors of recurrent rotator cuff tear after primary repair based on literature [J].Shandong Medical Journal,2019,61(33):66-70.DOI:10.3969/j.issn.1002-266X.2021.33.016.
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于万涛,俞明晨. 肩袖损伤修复术后再撕裂的相关因素与预测[J]. 中国矫形外科杂志, 2024, 32 (23): 2140-2145. DOI:10.20184/j. cnki. Issn1005-8478.100966.
YUWan-tao, YUMing-chen. Risk factors and prediction of rotator cuff re-tear after arthroscopic repair[J]. Orthopedic Journal of China , 2024, 32 (23): 2140-2145. DOI:10.20184/j. cnki. Issn1005-8478.100966.

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  • 收稿日期:2023-12-28
  • 最后修改日期:2024-07-18
  • 在线发布日期: 2024-12-04