肩袖损伤修复术后再撕裂的相关因素与预测△

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

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.