冈上肌腱撕裂术前MRI测量与术中所见对比△

Comparison of preoperative MRI measurements and intraoperative findings of supraspinatus tendon tear

摘要:

[目的]对比术前 MRI 测量与术中所见，探讨 MRI 诊断冈上肌腱全层撕裂的价值。[方法]回顾性分析 2017 年 1 月 —2023 年 12 月冈上肌腱全层撕裂 41 例患者的临床资料。根据术中镜下测量撕裂长度分重度组（长度≥3 cm）与轻中度组（长度＜3 cm）。比较两组术前 MRI 和术中指标。对组间差异有统计学意义的 MRI 评估指标行 ROC 分析。[结果]依据术中肩袖撕裂程度所见将患者分为重度组 14 例，轻中度组 27 例。重度组的术中测量撕裂长度 [(40.0±7.8) mm vs (17.9±4.2) mm, P＜0.001]、冠状面肌腱撕裂长度（coronal length, CL）[(13.6±5) mm vs (6.2±3.1) mm, P＜0.001]、水平面肌腱撕裂长度（horizontal length, HL）[(16.1± 5.5) mm vs (9.0±2.3) mm,P＜0.001]、肌腱撕裂校正长度（combined length, CoL）[(21.8±5.3) mm vs (11.1±3.1) mm, P 0.001]、肩峰下积液厚度（subacromial thickness of fluid accumulation, STFA）[(4.1±2.1) mm vs (2.7±1.7) mm, P=0.033] 均显著大于轻中度组。但是，两组在肩关节前方和内侧积液发生率、肩峰肱骨间距（acromiohumeral interval distance, AHID）、横断面喙肱距离（coracohumeral dis- tance, CHD 横断）的差异均无统计学意义（P＞0.05）。ROC 分析表明，MRI 测得冈上肌腱 CoL、CL、HL 和 STFA 预测术中测量撕裂大小的曲线下面积（area under curve, AUC）分别为 0.950、0.878、0.865、0.694。[结论] 综合两个或两个以上 MRI 测量指标可以准确评估冈上肌腱全层撕裂的严重程度，校正撕裂长度的诊断效能最高。

Abstract:

[Objective] To evaluate the value of MRI in diagnosis of supraspinatus tendon tear by comparing preoperative MRI measurements with intraoperative findings. [Methods] A retrospective study was done on 41 patients who had total supraspinatus tendon tear treated surgically from January 2017 to December 2023. Based on the intraoperative tear length, the patients were divided into the severe group with tear length ≥3 cm, and mild to moderate group with tear length ＜3 cm. The preoperative MRI and intraoperative findings were compared between the two groups. ROC analysis was performed for MRI predicating severity of tendon tear using the parameters statistically significant between the two groups. [Results] According to the extent of rotator cuff tear found during operation, 14 patients fall into the severe group, while the remaining 27 paitents were in the mild to moderate group. The severe group proved significantly greater than the mild to moderate group in terms of tear length intraoperatively measured [(40.0±7.8) mm vs (17.9±4.2) mm, P 0.001], as well as preoperative MRI measurments, including coronal length (CL) of tendon tear [(13.6±5) mm vs (6,6.2±3.1) mm, P 0.001], horizontal length (HL) of tendon tear [(16.1± 5.5) mm vs (9.0±2.3) mm, P 0.001], combined length (CoL) of tendon tear [(21.8±5.3) mm vs (11.1±3.1) mm, P 0.001], and the subacromial thickness of fluid accumulation (STFA) [(4.1±2.1) mm vs (2.7±1.7) mm, P 0.033]. However, there were no significant difference in the incidence of anteromedial glenohumeral effusion, acromiohumeral interval distance (AHID), and coracohumeral distance (CHD) between the two groups (P＞0.05). As results of ROC analysis, the area under curve (AUC) of CoL, CL, HL and STFA measured by preoperative MRI in predicting intraoperative tear extent was 0.950, 0.878, 0.865 and 0.694, respectively. [Conclusion] Combining two or more MRI measurements can accurately predict the severity of supraspinatus tendon tears, and the diagnostic efficacy of the combined length measured in preoperative MRI is the highest