肩袖损伤术后再撕裂的危险因素分析

Risk factors for re-tearing after rotator cuff injury surgery

目的分析影响肩袖损伤术后再撕裂的独立危险因素。方法选择我院收治的肩袖损伤患者共192例,按照是否发生术后再撕裂分为观察组(67例)和对照组(125例),比较2组患者一般资料、受伤情况及手术情况。采用多因素Logistic回归分析肩袖损伤术后再撕裂的独立危险因素,绘制受试者工作特征(ROC)曲线评估其预测价值。结果2组患者BMI、吸烟、饮酒、合并糖尿病、骨密度等一般资料比较差异具有统计学意义(P<0.05);2组患者撕裂方式、撕裂程度、术前肩关节前屈活动度、肩峰下间隙、肩关节临界角(CSA)等受伤情况比较差异具有统计学意义(P<0.05);2组患者手术缝合技术、手术时间、锚钉类型、缝线磨损、缝线数量等手术情况比较差异具有统计学意义(P<0.05)。Logistic回归分析显示,合并糖尿病、撕裂>3~5 cm、单排缝合技术、金属锚钉、骨密度≤-2.5 g/cm^(3)是肩袖损伤患者术后再撕裂的独立危险因素,其预测肩袖损伤患者术后再撕裂的曲线下面积(AUC)为0.854,临界值为0.467,敏感度、特异度分别为68.66%、91.20%(Z=11.636,P<0.0001)。结论合并糖尿病、撕裂>3~5 cm、单排缝合技术、金属锚钉、骨密度≤-2.5 g/cm^(3)是肩袖损伤患者术后再撕裂的独立危险因素,对可控危险因素进行有效干预可以降低患者术后再撕裂的发生风险。

Objective To analyze the independent risk factors for re-tearing after rotator cuff injury surgery.Methods A total of 192 patients with rotator cuff injury admitted to our hospital were selected and divided into the observation group(67 cases)and the control group(125 cases)according to whether postoperative re-tearing occurred.The general information,injury condition and surgery condition of the patients in the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors for re-tearing after rotator cuff injury surgery,the receiver operating characteristic(ROC)curve was drawn to evaluate its predictive value.Results There were statistically significant differences in general information such as BMI,smoking,drinking,combined diabetes mellitus and bone mineral density between the two groups(P<0.05).There were statistically significant differences in injury condition such as tearing mode,tearing degree,preoperative anterior flexor motion of shoulder joint,subacromial space and critical shoulder angle(CSA)between the two groups(P<0.05).There were statistically significant differences in surgery condition such as surgical suture technique,surgical time,anchor type,suture wear and suture number between the two groups(P<0.05).Logistic regression analysis showed that combined diabetes mellitus,tear>3~5 cm,single-row suture technique,metal anchor,and bone mineral density≤-2.5 g/cm^(3) were the independent risk factors for postoperative re-tearing in patients with rotator cuff injury,the area under the curve(AUC)to predict postoperative re-tearing in patients with rotator cuff injury was 0.854,with the critical value of 0.467,and the sensitivity and specificity were 68.66% and 91.20%,respectively(Z=11.636,P<0.0001).Conclusion Combined diabetes mellitus,tear>3~5 cm,single-row suture technique,metal anchor,and bone mineral density≤-2.5 g/cm^(3) are the independent risk factors for postoperative re-tearing in patients with rotator cuff injury.Effective intervention based on controllable risk factors can reduce the risk of postoperative re-tearing in patients.