肩关节临界角和肩峰指数对肩袖大面积撕裂修复术后的功能效果没有影响。

IF 2.7 Q1 ORTHOPEDICS Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-08-03 DOI:10.1016/j.jisako.2024.07.008

Yehia H. Bedeir , Brian M. Grawe

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引用次数: 0

摘要

目的：临界肩角（CSA）和肩峰指数（AI）是影响肩袖撕裂风险和修复效果的两个影像学标志。本研究旨在确定CSA和AI对肩袖大面积撕裂以及修复后功能结果的影响。假设后上方撕裂的 CSA 和 AI 将高于前上方撕裂：方法：对接受了两处肩袖肌腱修复手术的患者的 X 光片进行了 CSA 和 AI 的回顾性测量。使用美国肩肘外科医生（ASES）评分和简单肩关节测试（SST）对术后至少六个月的功能结果进行评估。根据修复的肌腱将患者分为前上方组和后上方组。两组患者的影像学测量结果和功能结果进行了比较。后上方组患者又分为低或高 CSA（截断值=39）和低或高 AI（截断值=0.75）。对所有可用的术前磁共振图像进行审查，并根据 Goutallier 分级法进行分级。采用多变量分析确定CSA、AI和Goutallier分级对功能预后的影响：结果：共纳入 86 名患者。后上方组的 CSA 和 AI 均明显高于前者（P=0.0143 和 0.0052）。平均随访33个月后，Goutallier分级0-1级患者的ASES和SST明显优于分级>1级的患者（多变量P分别为0.03和0.009）。低CSA组和高CSA组以及AI组在修复后的功能结果方面没有统计学意义上的差异（多变量P = 0.9）：结论：较高的临界肩角和肩峰指数似乎会增加肩袖后上撕裂的风险，而不是肩袖前上撕裂。结论：临界肩角和肩峰指数越高，肩袖后方撕裂的风险似乎比肩袖前方撕裂的风险更高，但这两个影像学参数都不会影响肩袖后方大面积撕裂患者修复后的功能预后：证据等级：III级。

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Critical shoulder angle and acromial index do not influence functional outcomes after repair of massive rotator cuff tears

Objectives

Critical shoulder angle (CSA) and acromial index (AI) are two radiographic signs that can influence the risk of rotator cuff tears and the outcomes of repair. The purpose of this study was to determine the influence of CSA and AI on massive cuff tears and on the functional outcomes after repair. The hypothesis was that CSA and AI would be higher in posterosuperior compared to anterosuperior tears.

Methods

CSA and AI were retrospectively measured on radiographs of patients who underwent repair of two rotator cuff tendons. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) at least six months postoperatively. Patients were divided according to the tendons repaired into anterosuperior group and posterosuperior group. Radiographic measurements and functional outcomes were compared. Patients in the posterosuperior group were subdivided into low or high CSA (cut-off value = 39), and into low or high AI (cut-off value = 0.75). All available preoperative magnetic resonance images were reviewed and graded according to Goutallier classification. Multivariate analysis was used to determine the influence of CSA, AI and Goutallier grade on functional outcomes.

Results

Eighty six patients were included. Both CSA and AI were statistically significantly higher in the posterosuperior group (p = 0.0143 and 0.0052, respectively). After a mean follow-up of 33 months, ASES and SST were significantly better in patients with Goutallier grades 0–1 than grades>1 (multivariate p = 0.03 and 0.009, respectively). No statistically significant differences were found between low and high CSA and AI groups in terms of functional outcomes of the posterosuperior group after repair (multivariate p = 0.9).

Conclusion

Higher CSA and AI seem to increase the risk of posterosuperior more than anterosuperior rotator cuff tears. Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair.