Variability of glenohumeral positioning and bone-to-tendon marker length measurements in repaired rotator cuffs from longitudinal computed tomographic imaging.
Variability of glenohumeral positioning and bone-to-tendon marker length measurements in repaired rotator cuffs from longitudinal computed tomographic imaging.
复制标题
通过纵向计算机断层扫描成像修复肩袖的盂肱定位和骨到肌腱标记长度测量的变异性。
DOI：
10.1016/j.jseint.2020.08.001
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发表时间：
2020-12
影响因子：
--
通讯作者：
Derwin KA
中科院分区：
文献类型：
--
作者：
Jun BJ;Sahoo S;Imrey PB;Baker AR;Erdemir A;Jin Y;Iannotti JP;Entezari V;Ricchetti ET;Bey MJ;Derwin KA
为了解决研究中对肌腱愈合的更客观和定量测量的需求，我们打算在修复的肌腱上植入不透射线标记的计算机断层扫描（CT）来测量肩袖修复后的肌腱缩回。在我们之前的一项小型研究中，13例患者中有12例在1年随访中平均收缩16.1±5.3 mm，超过10.0 mm，因此肌腱收缩似乎是一种常见的临床现象。本研究的目的是利用肩袖修复后1年内获得的5次纵向CT扫描，评估由于实现完美手臂重新定位的实际变化而导致的盂肱定位的变异性，并估计骨-肌腱标记物长度测量的相关测量变异性。48例患者行肩袖修复术，术中在修复部位放置不透射线的肌腱标记物。所有患者在手术当天以及术后3周、12周、26周和52周进行了手臂侧位CT扫描。每次扫描测量肱骨关节位置（由肱骨相对于肩胛骨的方向和距离定义）和骨-肌腱标记物长度。患者内肩关节位置测量的变化由患者内标准偏差（sd）描述，骨-肌腱标记物长度的变化由测量的标准误差（SEMs）和95%置信水平最小可检测距离（MDD95）和变化（MDC95）描述。48例患者的5次纵向CT扫描平均盂肱关节方向为12.6°外展，0.4°屈曲和-0.1°内旋。患者内盂肱位的SDs（95%可信区间）为伸/屈3.0°（2.7°-3.4°），外展/内收5.2°（4.6°-5.8°），内/外旋8.2°（7.3°-9.2°）。肱骨盂骨距离的SDs在任何方向上均小于1 mm。骨-肌腱长度的估计sem与任何横跨修复的肌腱标记物的常见值2.4 mm一致，其中MDD95为4.7 mm， MDC95为6.7 mm。当在体积记录的纵向CT扫描上测量肌腱标记物手术当日位置到其新位置的距离时，5毫米或以上的表观肌腱缩回可被认为高于通常的测量变化范围。使用植入的不透射线肌腱标记物测量肌腱缩回，为量化肩袖修复后结构愈合的普遍预期变化提供了客观和足够可靠的手段。
To address the need for more objective and quantitative measures of tendon healing in research studies, we intend to use computed tomography (CT) with implanted radiopaque markers on the repaired tendon to measure tendon retraction following rotator cuff repair. In our small prior study, retraction at 1-year follow-up averaged 16.1± 5.3 mm and exceeded 10.0 mm in 12 of 13 patients, and thus tendon retraction appears to be a common clinical phenomenon. This study's objectives were to assess, using 5 longitudinal CT scans obtained over 1 year following rotator cuff repair, the variability in glenohumeral positioning because of pragmatic variations in achieving perfect arm repositioning and to estimate the associated measurement variability in bone-to-tendon marker length measurements. Forty-eight patients underwent rotator cuff repair with intraoperative placement of radiopaque tendon markers at the repair site. All patients had a CT scan with their arms at the side on the day of surgery and at 3, 12, 26, and 52 weeks postoperatively. Glenohumeral position (defined by the orientation and distance of the humerus with respect to the scapula) and bone-to-tendon marker lengths were measured from each scan. Within-patient variation in glenohumeral position measurements was described by their pooled within-patient standard deviations (SDs), and variation in bone-to-tendon marker lengths by their standard errors of measurement (SEMs) and 95% confidence level minimally detectable distances (MDD95) and changes (MDC95). The mean glenohumeral orientation from the 5 longitudinal CT scans averaged across the 48 patients was 12.6° abduction, 0.4° flexion, and –0.1° internal rotation. Within-patient SDs (95% confidence intervals) of glenohumeral orientation were 3.0° (2.7°-3.4°) in extension/flexion, 5.2° (4.6°-5.8°) in abduction/adduction, and 8.2° (7.3°-9.2°) in internal/external rotation. The SDs of glenohumeral distances were less than 1 mm in any direction. The estimated SEMs of bone-to-tendon lengths were consistent with a common value of 2.4 mm for any of the tendon markers placed across the repair, with MDD95 of 4.7 mm and MDC95 of 6.7 mm. Apparent tendon retraction of 5 mm or more, when measured as the distance from a tendon marker's day of surgery location to its new location on a volumetrically registered longitudinal CT scan, may be considered above the usual range of measurement variation. Tendon retraction measured using implanted radiopaque tendon markers offers an objective and sufficiently reliable means for quantifying the commonly expected changes in structural healing following rotator cuff repair.