MRI影像指标与肩袖损伤患者保守治疗短期疗效的相关性分析

Correlation analysis of pretreatment MRI characteristics and short-term efficacy of conservative intra-articular injection in patients with rotator cuff injury

目的:探讨MRI影像指标中与肩袖损伤患者经关节腔注射药物保守治疗短期疗效相关的因素。方法:纳入采取保守治疗的148例肩袖损伤患者作为研究对象,148例患者均行MRI检查。治疗前评估的因素包括关节囊积液程度、冈上肌(SSP)肌腱回缩距离、肩胛下肌(SSC)肌腱撕裂程度、冈下肌(ISP)肌腱撕裂程度以及采用Goutallier分类方法评估的SSC、SSP和ISP肌肉脂肪浸润程度分级。于保守治疗前和治疗后3个月采用上肢功能障碍(DASH)量表对患者进行肩关节功能评分。结果:治疗后,108例(72.97%,改善组)患者肩关节功能和疼痛改善,40例(27.03%,未改善组)患者未改善。两组治疗前DASH评分比较差异无统计学意义(P>0.05),治疗后差异有统计学意义(P<0.001)。统计学分析结果显示,改善组与未改善组的关节囊积液分级、SSP回缩距离、SSC肌腱撕裂程度、ISP肌腱撕裂程度和SSC Goutallier分级比较差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,SSC肌腱撕裂与治疗后未改善显著相关(P值<0.05)。结论:SSC肌腱撕裂是肩袖损伤患者保守治疗后疼痛和肩关节功能未改善的独立预测因素。

Objective:To investigate the relationship ofcharacteristics of MRI imaging indicators and the short-term efficacy of conservative intra-articular injection in patients with rotator cuff injury.Methods:Hundred forty-eight patients with rotator cuff injury with conservative treatment were included as research subjects.MRI was performed using a GE Signal 1.5T scanner.Factors assessed before treatment included the degree of joint capsule effusion,the distance of supraspinatus muscle(SSP)tendon retraction,the degree of subscapularis muscle(SSC)tendon tear,the degree of infraspinatus muscle(ISP)tendon tear,and SSC,SSP and ISP grade of muscle fat infiltration assessed using the Goutallierclassification.Before and after 3 months conservative treatment,the patients were evaluated with the disability of the Arm,Shoulder,and Hand(DASH)scale.Results:After treatment,the condition of shoulder joint function improved and pain releived for 108 patients(72.97%),while 40 patients(27.03%)not.There was no statistically significant difference in DASH scores between two groups before treatment(P>0.05),however,there was after treatment(P<0.001).Univariate analysis results showed that there were significant differences in the grade of joint capsule effusion,SSP retraction distance,SSC tendon tear degree,ISP tendon tear degree,and SSC Goutallier grade between two groups(all P<0.05).In Multivariate Logistic regression analysis,the results showed that SSC tendon tear was significantly correlated with no effect improvement after treatment(all P<0.05).Conclusion:SSC tendon tear is an independent predictor of pain releive and failure to improve shoulder function in patients with rotator cuff injury after conservative treatment.