肩关节解剖学因素与肩袖修补术后关节僵硬的相关性分析

Correlation analysis between anatomical features of shoulder joint and postoperative stiffness after rotator cuff repair

目的探讨肩关节解剖学因素与肩袖修补术后关节僵硬的相关性。方法回顾性分析2016年3月至2021年12月于民航总医院骨科行肩袖修补术的肩袖损伤患者212例,男97例、女115例,年龄(58.87±9.69)岁(范围41~72岁)。根据术后3个月是否发生关节僵硬分为僵硬组与无僵硬组。采用患者肩关节CT三维重建测量并计算所有患者术前及术后第1天临界肩关节角(critical shoulder angle,CSA)、肩峰指数(acromial index,AI)、肩峰外侧角(lateral acromion angle,LAA),收集术前和术后3个月肩关节活动度(前屈、外展、外旋)及年龄、性别、病程、体质指数、肩袖肌腱脂肪浸润程度、肩袖撕裂程度、缝合方式、术前是否并发僵硬。比较两组解剖因素及临床特征的差异,将差异有统计学意义的指标纳入二分类变量logistic回归分析。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估与术后关节僵硬相关因素的预测效能。结果僵硬组43例,无僵硬组169例。两组年龄、性别、病程、体质指数、肩袖肌腱脂肪浸润程度、肩袖撕裂程度、缝合方式、术前肩关节前屈、外展、体侧外旋活动度等因素的差异无统计学意义(P>0.05)。僵硬组术前并发僵硬的患者比例较无僵硬组更高,差异有统计学意义(χ^(2)=40.38,P<0.001)。术后3个月僵硬组患者术后CSA、AI较无僵硬组更大(t=5.44,P<0.001;t=4.89,P<0.001),术后LAA较无僵硬组更小(t=-5.86,P<0.001)。术前并发僵硬、术后AI较大及LAA较小均是肩袖缝合术后关节僵硬的危险因素[OR=9.32,95%CI(3.44,25.27),P<0.001;OR=2.39,95%CI(1.58,3.62),P<0.001;OR=0.64,95%CI(0.46,0.91),P=0.012]。术后CSA、AI及LAA对肩袖修补术后关节僵硬有一定的预测效能,术后LAA灵敏度最高,术后CSA特异性最高,术后CSA、AI、LAA最佳截断值分别为34.4°、0.70、74.5°,预测术后关节僵硬的AUC分别为0.76[OR=0.98,95%CI(0.69,0.84),P<0.001]、0.78[OR=2.39,95%CI(0.70,0.84),P<0.001]、0.76[OR=0.64,95%CI(0.68,0.83),P<0.001]。结论术后CSA、AI和LAA均对肩袖修补术后关节僵硬有一定预测作用;术后第1天CSA、AI较大或LAA较小提示术后关节僵硬的风险升高,且术后LAA灵敏度最高,术后CSA特异性最高。

Objective To investigate the correlation between anatomical features of shoulder joint and postoperative stiffness after rotator cuff repair.Methods 212 patients diagnosed with rotator cuff injury undergoing rotator cuff repair in Civil Aviation General Hospital from March 2016 to December 2021 were enrolled.There were 97 male and 115 female with an average age of 58.87±9.69 years old(range,41-72).The patients were divided into stiffness group(SG)and non-stiffness group(NG)according to the range of shoulder joint motion at 3-month after operation.Preoperative and postoperative joint anatomical features including critical shoulder angle(CSA),acromial index(AI),lateral acromion angle(LAA)were measured and calculated through CT scan and 3-dimension reconstruction.Age,sex,course of disease,body mass index,tendon fatty infiltration degree,type of rotator cuff injury according to DeOrio&Cofield classification,suture method,and preoperative and 3-month postoperative range of shoulder motion(flexion,abduction,and external rotation),preoperative stiffness condition were collected.All factors between two groups were compared,and binomial logistic regression analysis was performed to find out the risk factors of postoperative joint stiffness.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of postoperative CSA,AI,and LAA for postoperative joint stiffness.Results 43 patients were enrolled in SG and 169 patients were enrolled in NG.Age,sex,course of disease,body mass index,tendon fatty infiltration degree,type of rotator cuff injury according to DeOrio&Cofield classification,suture method,and preoperative range of shoulder motion(flexion,abduction,and external rotation)between two groups were insignificantly different(P>0.05).The ratio of patients with preoperative stiffness in SG is higher than that in NG(χ^(2)=40.38,P<0.001).Postoperative CSA and AI of SG were greater than those of NG(t=5.44,P<0.001;t=4.89,P<0.001),and postoperative LAA of SG was smaller than that of NG group(t=-5.86,P<0.001).Preoperative stiffness,large postoperative AI and small postoperative LAA were all risk factors of joint stiffness after rotator cuff suture[OR=9.32,95%CI(3.44,25.27),P<0.001;OR=2.39,95%CI(1.58,3.62),P<0.001;OR=0.64,95%CI(0.46,0.91),P=0.012].Postoperative CSA,AI and LAA had a certain predictive effect on postoperative joint stiffness(AUC>0.70).LAA was the most sensitive factor and CSA was the most specific factor.The optimal cutoff values of CSA,AI and LAA were 34.4°,0.70 and 74.5°respectively,and the AUC for predicting postoperative joint stiffness were 0.76[OR=0.98,95%CI(0.69,0.84),P<0.001]、0.78[OR=2.39,95%CI(0.70,0.84),P<0.001]、0.76[OR=0.64,95%CI(0.68,0.83),P<0.001].Conclusion Postoperative CSA,AI and LAA had predictive efficacy on joint stiffness after rotator cuff repair.The greater postoperative CSA and AI or smaller postoperative LAA indicates increased risk of postoperative joint stiffness.LAA was the most sensitive factor and CSA was the most specific factor.