Magnetic resonance imaging of arthroscopic supraspinatus tendon repair
Magnetic resonance imaging of arthroscopic supraspinatus tendon repair
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DOI：
10.2106/jbjs.f.00749
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发表时间：
2007-08-01
影响因子：
5.3
通讯作者：
Habermeyer, Peter
中科院分区：
文献类型：
--
作者：
Liem, Dennis;Lichtenberg, Sven;Habermeyer, Peter
背景资料：虽然一些研究已经记录了非常好的关节镜下肩袖修复的临床结果，很少有作者专门评估了肩袖的完整性，冈上肌萎缩，脂肪浸润及其对临床outcome.Methods的影响：我们评估了连续53例（平均年龄60.9岁）谁经历了关节镜下修复孤立冈上肌腱撕裂。在平均随访26.4个月后，所有患者均使用Constant评分进行临床评估，并在我们的机构进行标准化磁共振成像。术前和术后磁共振图像由两名独立的观察者进行评价，这些观察者对患者的临床结局不知情。评价标准为袖带完整性;冈上肌萎缩;冈上肌、冈下肌和肩胛下肌脂肪浸润。这些结果与临床outcome.Results：无论肌腱的完整性，每个参数的常数评分修复后显着改善。总体平均Constant评分从53.5分提高到83.4分（p < 0.001）。在我们的系列中，再撕裂率为25%（53例中的13例）。与修复完好的患者相比，再撕裂患者的外展强度显著降低（p = 0.043），Constant总分显著降低（p = 0.012）。术前冈上肌萎缩程度较高和冈上肌2期脂肪浸润是再撕裂的阳性预测因素。此外，年龄较大是再撕裂的重要预测因素（p = 0.011）。当修复保持完整时，肩袖结构变化的进展停止，但脂肪浸润或肌肉萎缩没有明显逆转。当修复失败，有显着的进展脂肪浸润和萎缩的suprospinatus.Conclusions：孤立冈上肌撕裂关节镜下修复的临床和结构的结果是相等的开放修复后报告。脂肪浸润和肌肉萎缩不能通过成功的关节镜修复逆转。术前较高程度的肌萎缩和脂肪浸润与撕裂的复发以及脂肪浸润和肌萎缩的进展和较差的临床结果相关。证据等级：治疗级IV。证据等级的完整描述见作者说明。
Background: While a number of studies have documented the very good clinical results of arthroscopic rotator cuff repair, very few authors have specifically assessed cuff integrity, supraspinatus atrophy, and fatty infiltration and their influence on the clinical outcome.Methods: We evaluated fifty-three consecutive patients (average age, 60.9 years) who had undergone arthroscopic repair of an isolated supraspinatus tendon tear. After an average duration of follow-up of 26.4 months, all patients were evaluated clinically with use of the Constant score and underwent standardized magnetic resonance imaging at our institution. The preoperative and postoperative magnetic resonance images were evaluated by two independent observers who were blinded to the clinical outcome of the patient. Evaluation criteria were cuff integrity; atrophy of the supraspinatus; and fatty infilitration of the supraspinatus, infraspinatus, and subscapularis. These findings were correlated to the clinical outcome.Results: Regardless of the tendon integrity, every parameter of the Constant score was significantly improved after the repair. The overall average Constant score was improved from 53.5 to 83.4 points (p < 0.001). The retear rate in our series was 25% (thirteen of fifty-three). Patients who had a retear had significantly less abduction strength (p = 0.043) and a significantly lower total Constant score (p = 0.012) than those who had an intact repair. A higher degree of preoperative supraspinatus atrophy and Stage-2 fatty infiltration of the supraspinatus were positive predictors of a retear. Also, an older age was an important predictor of a retear (p = 0.011). Progression of structural changes in the rotator cuff was halted when the repair remained intact, but there was no significant reversal of fatty infiltration or muscle atrophy. When the repairs failed, there was significant progression of fatty infiltration and atrophy of the supraspinatus.Conclusions: The clinical and structural results of arthroscopic repairs of isolated supraspinatus tears are equal to those reported following open repair. Fatty infiltration and muscle atrophy cannot be reversed by successful arthroscopic repair. Higher degrees of muscular atrophy and fatty infiltration preoperatively are associated with recurrence of the tear as well as progression of fatty infiltration and muscular atrophy and an inferior clinical result.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.