肩袖撕裂的相关危险因素分析及预测效能评估

Risk factors for rotator cuff tear and corresponding prediction efficacy

目的:分析肩袖撕裂的相关危险因素并评估预测效能。方法:采用病例对照研究分析2020年6月至2021年6月青岛大学附属医院收治的69例肩袖撕裂患者(肩袖撕裂组)和51例志愿者及正常体检者(正常对照组),其中男55 例,女65例;年龄34~77岁[(58.2±7.2)岁]。体重指数(BMI)19.5~32.4 kg/m 2[(25.4±2.5)kg/m 2]。采用单因素分析两组性别、年龄、高血压病史、吸烟病史、糖尿病病史、BMI、肱骨大结节角及肱骨大结节切迹角与肩袖撕裂的相关性,将差异有统计学意义的因素纳入多因素Logistic回归分析,从而明确肩袖撕裂的独立危险因素。采用Spearman分析两组间因素的相关性。以受试者工作特征(ROC)曲线分析危险因素对肩袖撕裂的预测效能。 结果:单因素分析结果显示,年龄、肱骨大结节角、肱骨大结节切迹角与肩袖撕裂有一定相关性( P均<0.05);性别、高血压病史、吸烟病史、糖尿病病史、BMI与肩袖撕裂不相关( P均>0.05)。多因素Logistic回归分析结果表明,肱骨大结节角、肱骨大结节切迹角与肩袖撕裂显著相关( P均<0.05)。Spearman分析结果显示,年龄与肱骨大结节角和肱骨大结节切迹角不相关( r=0.09,0.13, P均>0.05),肱骨大结节角与肱骨大结节切迹角呈显著正相关( r=0.76, P<0.01)。当肱骨大结节角、肱骨大结节切迹角最佳截断值分别为70.05°和150.55°时,预测肩袖撕裂的ROC曲线下面积(AUC)分别为0.79(95% CI 0.71~0.87, P<0.01),0.81(95% CI 0.74~0.89, P<0.01)。 结论:肱骨大结节角和肱骨大结节切迹角是肩袖撕裂的独立危险因素,肱骨大结节角及肱骨大结节切迹角越大,越容易发生肩袖撕裂,且肱骨大结节切迹角的预测效能较高。

Objective To analyze the risk factors for rotator cuff tear and evaluate the corresponding prediction efficacy.Methods A case-control study was conducted in 69 patients with rotator cuff tear admitted to Affiliated Hospital of Qingdao University from June 2020 to June 2021(rotator cuff tear group)and 51 normal volunteers or medical examiners(normal control group).There were 55 males and 65 females,with the age range of 34-77 years[(58.2±7.2)years].Body mass index(BMI)ranged from 19.5-32.4 kg/m2[(25.4±2.5)kg/m2].Univariate analysis was performed for the correlation of gender,age,history of hypertension,history of smoking,history of diabetes,BMI,angle of humeral greater tuberosity and notch angle of humeral greater tuberosity with rotator cuff tear in the two groups.Factors with statistically significant differences were included in multivariate Logistic regression analysis to determine the independent risk factors for rotator cuff tear.Spearman correlation analysis was used to find factor correlation between the two groups.The receiver operating characteristic(ROC)curve of relevant factors for the diagnosis and prediction of rotator cuff tear was analyzed.Results Univariate analysis showed that age,angle of humeral greater tuberosity and notch angle of humeral greater tuberosity related to rotator cuff tear(all P<0.05).On the contrary,gender,history of hypertension,history of smoking,history of diabetes and BMI were not correlated with rotator cuff tear(all P>0.05).Multivariate Logistic regression analysis showed significant correlations of angle of humeral greater tuberosity and notch angle of humeral greater tuberosity with rotator cuff tear(all P<0.05).Spearman correlation analysis showed that age was not correlated with angle of humeral greater tuberosity and notch angle of humeral greater tuberosity(r=0.09,0.13,all P>0.05),but there was significant positive correlation between angle of humeral greater tuberosity and notch angle of humeral greater tuberosity(r=0.76,P<0.01).When the optimal cutoff values of angle of humeral greater tuberosity and notch angle of humeral greater tuberosity were 70.05°and 150.55°,the area under the ROC curve(AUC)for predicting rotator cuff tear was 0.79(95%CI 0.71-0.87,P<0.01)and 0.81(95%CI 0.74-0.89,P<0.01).Conclusions Angle of humeral greater tuberosity and notch angle of humeral greater tuberosity are independent factors for rotator cuff tear,and larger angles suggest higher prevalence of rotator cuff tear.Besides,the notch angle of humeral greater tuberosity has relatively better predictive performance.