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修复后肩袖的磁共振成像评估:肌腱再断裂的发生率、大小、位置及临床相关性

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture.

作者信息

Mellado J M, Calmet J, Olona M, Ballabriga J, Camins A, Pérez del Palomar L, Giné J

机构信息

Servicio de Radiodiagnóstico, Hospital Reina Sofía de Tudela, Carretera Tarazona, km 4, 31500, Tudela, Navarra, Spain.

出版信息

Eur Radiol. 2006 Oct;16(10):2186-96. doi: 10.1007/s00330-006-0147-z. Epub 2006 Mar 2.

Abstract

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.

摘要

本研究的目的是使用磁共振(MR)成像来评估全层肩袖撕裂(RCT)完全修复术后肌腱再断裂的发生率、大小、位置及临床相关性。本研究回顾性纳入了74例患者的78例经手术证实的全层肩袖撕裂。使用加州大学洛杉矶分校评分进行临床评估。对术后MR成像进行评估,以确定肌腱再断裂的发生率、大小和位置。在平均48.4个月的随访中,62例肩部(79.5%)预后良好,45例肩部(57.6%)在MR成像研究中显示再断裂。再断裂在预后中等至较差的患者(81.3%)、手术证实为双肌腱撕裂(78.9%)或三肌腱撕裂(100%)以及术前冈上肌脂肪变性大于1级的患者(91.6%)中更为常见。这些亚组中的再断裂也明显更大。尽管再断裂的发生率很高,但各种大小的RCT完全修复在相当比例的患者中可能有良好的预后。术前撕裂大小和肌肉脂肪变性程度会影响再断裂的发生率和大小。冈上肌撕裂修复后,再断裂倾向于侵犯肌腱的后侧。

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