冈上肌腱撕裂术后肌腱愈合评估方法

Evaluation methods of postoperative healing of supraspinatus tendon tear

目的总结近年冈上肌腱撕裂术后肌腱愈合评估方法,以期为临床提供参考。方法于CNKI、万方、PubMed、外文医学信息资源检索平台(FMRS)数据库,检索与冈上肌腱撕裂诊断及术后愈合评价指标有关的文献,检索范围2005年—2022年,最终纳入50篇文献进行综述。结果冈上肌腱撕裂是常见肩关节疾病,临床采用体格检查、临床评分以及影像学检查对术后肌腱愈合情况进行预测及评估。其中,体格检查及临床评分为无创且最经济的方法,但准确性及敏感性相对较低,仅作为辅助方法。基于X线片测量的肱骨肩峰距离(acromio-humeral distance,AHD)及肱骨上移指数(upward migration index,UMI)可直观反映冈上肌腱厚度变化,但对其内部是否存在撕裂无法判别。超声及MRI是临床诊断冈上肌腱撕裂的主要检查方法,但目前常用的MRI序列无法精准判断肌腱内部愈合情况,剪切波弹性成像技术(shear wave elastrography,SWE)及超短回波时间(ultrashort-echo-time,UTE)技术均是近年最新研究方向,但SWE应用相关研究存在相反结论,对于其原理及与肌腱的关系有待进一步研究。UTE技术具有良好的临床效果,采用其测得的T2*值评估肌腱愈合情况较传统Sugaya分型更准确。结论基于X线片测量的AHD和UMI以及基于UTE技术测量的T2*值均可作为有效的冈上肌腱撕裂术后愈合评估指标,可与体格检查、临床评分共同作为冈上肌腱撕裂患者术后随访评估方法。

Objective To summarize the evaluation methods of postoperative healing of supraspinatus tendon tear in recent years,in order to provide reference for clinic.Methods CNKI,Wanfang,PubMed,and Foreign Medical Literature Retrieval Service(FMRS)databases were used to search the literatures between 2005 and 2022.The literature related to the diagnosis and postoperative healing of supraspinatus tendon tear was included.Finally,50 articles were reviewed.Results Supraspinatus tendon tear is a common shoulder disease.Physical examination,clinical score,and imaging examination are used to predict and evaluate the postoperative healing.Among them,physical examination and clinical score are non-invasive and the most economical methods,but their accuracy and sensitivity are lower than imaging examination,so they can only be used as auxiliary methods.The acromio-humeral distance(AHD)and upward migration index(UMI)measured by X-ray films can directly reflect the change of supraspinatus tendon thickness,but they are impossible to distinguish whether there is tear or not.Ultrasound and MRI are the main methods for the clinical diagnosis of supraspinatus tendon tear,but the commonly used MRI sequence can not accurately judge the internal healing of the tendon.Shear wave elastrography(SWE)and ultrashort-echo-time(UTE)techniques are the latest research directions in recent years,but different studies have shown opposite conclusions on the application of SWE technique.This conclusion shows that the principle of SWE technique and its relationship with tendons need to be further studied.UTE technique has good clinical effect,and the T2*value obtained by UTE technique is more accurate than that of traditional Sugaya typing,but there are still few research samples.Conclusion AHD and UMI measured by X-ray film and T2*value measured by UTE technique can be used as effective methods for evaluating the healing of supraspinatus tendon tear after repairing,and can be used as a follow-up evaluation method combined with physical examination and clinical score for patients with supraspinatus tendon tear.