Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs
Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs
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DOI：
10.1016/j.jse.2017.03.024
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发表时间：
2017-10-01
影响因子：
3
通讯作者：
Collin, Philippe
中科院分区：
文献类型：
--
作者：
Godeneche, Arnaud;Elia, Fanny;Collin, Philippe
背景：脂肪渗透(FI)影响肩袖修复的结果。大多数临床医生认为冈下肌的FI，无论它是撕裂的还是完整的，因为它受到的影响最快。本研究的目的是报告孤立性冈上肌修复的长期效果，并确定其与冈下肌和冈上肌FI的关系。方法：检索182例接受孤立性冈上肌撕裂修补术的患者的术前磁共振成像资料。结果：术前冈上肌FI(52%)大于冈下肌FI(29%)。10年恒定分数受冈上肌FI影响(P=.006)，而受冈下肌FI影响(P=.422)。多变量回归分析证实，女性患者、重复性工作以及除开放手术外的冈上肌1期和2期FI患者的恒定评分显著较低。再撕裂率(Sugaya IV-V型)也受冈上肌FI的影响(P=.001)，而不受冈下肌FI的影响(P=.979)。0、1和2期冈上肌FI的肩部再撕裂率分别为10%、22%和31%。多变量回归分析表明，1期和2期的FI均显著增加了冈上肌再撕裂的几率。结论：恒定的评分和再撕裂率与撕裂的冈上肌(1期)的FI显著相关，而与完整的冈下肌的FI无关。作者建议，在脂肪堆积之前，尤其是对于年轻、活跃的患者，应考虑快速手术治疗。(C)2017年《肩肘外科杂志》董事会。版权所有。
Background: Fatty infiltration (FI) compromises outcomes of rotator cuff repairs. Most clinicians consider FI of the infraspinatus, whether it is torn or intact, because it is most rapidly affected. The purpose of this study was to report long-term outcomes of isolated supraspinatus repairs and to determine their associations with FI of the infraspinatus and supraspinatus.Methods: The records of 182 patients who underwent repair of isolated supraspinatus tears and had preoperative magnetic resonance imaging were retrieved. Of these, 147 patients were evaluated at 10 years' follow-up using the Constant score and magnetic resonance imaging scans.Results: Preoperative FI was greater in the supraspinatus (52% stage >= 1) than in the infraspinatus (29% stage >= 1). The 10-year Constant scores were influenced by FI of the supraspinatus (P =.006) but not of the infraspinatus (P =.422). Multivariable regression confirmed that Constant scores were significantly lower for female patients, repetitive work, and stage 1 and stage 2 FI of the supraspinatus in addition to open surgery. Retear rates (Sugaya types IV-V) were also influenced by FI of the supraspinatus (P =.001) but not of the infraspinatus (P =.979). Shoulders with supraspinatus FI at stages 0, 1, and 2 had retear rates of 10%, 22%, and 31%, respectively. Multivariable regression affirmed that the odds of retears are significantly increased by both stage 1 and stage 2 FI of the supraspinatus.Conclusions: The Constant scores and retear rates were significantly associated with FI of the torn supraspinatus (stage >= 1) but not of the intact infraspinatus. The authors recommend that rapid surgical intervention be considered, before accumulation of fat, especially for young, active patients. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.