肩袖修复术后再次撕裂的危险因素分析

Factors associated with retear after rotator cuff repair

背景肩袖撕裂在上肢运动损伤中较常见,其主要治疗方式为关节镜下肩袖修复术。但部分患者因为各种因素,出现术后再次撕裂,鲜有相关研究分析其发生的危险因素。目的分析患者在接受肩袖修复术后发生再次撕裂的相关危险因素,以期有针对性地采取防治措施。方法选取2016年10月-2019年5月在西南医科大学附属医院行初次肩袖修复术的135例患者临床资料,在术后2周、4周、8周和12周时完成术后随访,根据患者是否发生术后肩袖再次撕裂分为病例组和对照组,采用单因素分析及多因素logistic回归分析肩袖修复术后发生再次撕裂的影响因素。结果纳入研究共135例患者,男性87例,女性48例,平均年龄(56.54±8.73)岁,平均随访时间(3.98±2.15)个月,有29例患者在肩袖修补术后出现肩袖再次撕裂。多因素logistic回归分析显示,糖尿病(OR=11.363,95%CI:2.841~45.455)、高血脂(OR=4.761,95%CI:1.351~16.949)、撕裂长度≥4 cm(OR=5.351,95%CI:1.420~19.891)、术前病程≥1年(OR=14.002,95%CI:3.648~53.744)、年龄≥60岁(OR=7.648,95%CI:1.881~31.100)与肩袖修复术后再次撕裂独立关联(P均<0.05)。结论有糖尿病史、高血脂、撕裂长度≥4 cm、术前病程≥1年、年龄≥60岁的患者发生肩袖修复术后再次撕裂的风险较高,临床医生与护理人员对上述危险因素采取有效的防治措施或可减少术后肩袖再次撕裂的发生。

Background Rotator cuff tears are common in upper limb sports injuries,and its main treatment is arthroscopic repair.However,some patients experience postoperative retear due to various factors,and there are few relevant studies in analysis of the risk factors for its occurrence.Objective To investigate the risk factors for retears after rotator cuff repair,so as to take targeted prevention and treatment measures.Methods Clinical data about 135 patients who underwent primary rotator cuff repair in the Affiliated Hospital of Southwest Medical University from October 2016 to May 2019 were retrospectively analyzed,and patients were followed up at 2,4,8 and 12 weeks after operation.The patients were divided into control group and case group according to whether they had postoperative rotator cuff retear.Univariate and logistic regression were used to analyze the influence factors of rotator cuff retear.Results A total of 135 patients were included in the study,including 87 males and 48 females,with a mean age of(56.54±8.73)years and a mean follow-up time of(3.98±2.15)months,and 29 patients developed rotator cuff re-tear after rotator cuff repair.Multivariate logistic regression analysis showed that diabetes mellitus(OR=11.363,95%CI:2.841-45.455),hyperlipidemia(OR=4.761,95%CI:1.351-16.949),tear length≥4 cm(OR=5.351,95%CI:1.420-19.891),preoperative duration≥1 year(OR=14.002,95%CI:3.648-53.744),and age≥60 years(OR=7.648,95%CI:1.881-31.100)were independent factors for re-tears after rotator cuff repair(all P<0.05).Conclusion Patients with diabetes history,hyperlipidemia,tear length≥4 cm,preoperative disease duration≥1 year,and age≥60 years have a higher risk of re-tear after rotator cuff repair,and it is important to take effective prevention and treatment measures for the above risk factors in clinical practice to reduce the occurrence of retear of rotator cuff after surgery.