肩袖撕裂术前MRI评估与修复术后疗效的相关性分析

Relationship between preoperative MRI shoulder findings and clinical outcome after rotator cuff repair

目的:研究肩袖撕裂患者术前磁共振(MRI)影像评估与修复术后临床效果的相关性,以评估肩袖撕裂患者的预后。方法:纳入2018年1月至2019年6月入院的71例肩袖全层撕裂并行关节镜下修复手术患者。所有患者术后1年完成上肢功能障碍(DASH)量表肩关节评分,测量术前MRI上肩袖撕裂回缩距离、撕裂宽度,评估肌腱退变、肌肉萎缩以及脂肪浸润程度。依据DASH评分将患者分为肩关节功能改善组(n=55)与未改善组(n=16),分析术前MRI影像评估与临床效果的相关性。结果:术前MRI肩袖撕裂宽度、回缩距离、肌腱退变程度与术后DASH肩关节功能评分呈正相关,肌肉萎缩以及脂肪浸润程度与术后DASH评分无相关性。结论:术前MRI显示肌腱撕裂范围大、回缩明显、肌腱退变程度重的患者,肩袖修复术后1年临床效果不佳。

Objective: To study the correlation between the preoperative MRI finding of patients with rotator cuff tear and the clinical outcome after rotator cuff repair, and to evaluate their prognosis.Methods: This retrospective study included a cohort of 71 patients who underwent surgical repair of a fullthickness rotator cuff tear admitted to hospital from January, 2018 to June, 2019. Patients completed the Disabilities of the Arm, Shoulder, and Hand(DASH) survey(lower score indicates less pain and disability) before and one year after surgery. One musculoskeletal radiologist blinded to the DASH scores measured the maximal anterior-posterior width and medial-lateral retraction of the rotator cuff tear on the preoperative MRI and assessed tendon degeneration and composite muscle atrophy and fatty infiltration. According to their DASH scores, the patients were divided into shoulder joint function improvement group(n=55) and non-improvement group(n=16), and the correlation between preoperative MRI findings and clinical effect was analyzed.Results: There was a significant positive association between the measured tear width, measured tear retraction, or tendon degeneration grade and the postoperative DASH score(all P<0. 05). There was no significant association between the composite muscle atrophy or fatty infiltration grade and the postoperative DASH score.Conclusion: Patients with larger rotator cuff tears, more tendon retraction, and more severe tendon degeneration have worse clinical outcome scores one year after rotator cuff repair.