Ogon P, Suedkamp N P, Jaeger M, Izadpanah K, Koestler W, Maier D
Center of Orthopedic Sports Medicine Freiburg, Freiburg, Germany.
Arthritis Rheum. 2009 Oct;60(10):2978-84. doi: 10.1002/art.24845.
To define prognostic factors in chronically symptomatic patients with calcific tendinitis of the shoulder.
We evaluated 420 patients (488 shoulders) in the context of a prospective cohort study. Epidemiologic data were assessed. The radiographic and sonographic appearance of the calcific deposits was classified. The mean period of nonoperative therapy was 4.4 years (range 0.5-13.7 years). After referral to our institution, standardized nonoperative therapy was continued for a minimum of 3 months. Failure of nonoperative therapy was defined as the persistence of symptomatic calcific tendinitis of the shoulder after a minimum of 6 months. Prognostic factors (determined at P < 0.05 by chi-square test) were analyzed by logistic regression.
Of the 420 patients, 269 (64%) were women, 151 (36%) were men. The mean age of the patients was 51.3 years (range 28-84 years). Occurrence of calcific tendinitis of the shoulder was unilateral in 84% and bilateral in 16%. Gärtner type I calcific deposits were found in 37%, type II in 32%, and type III in 31%. Failure of nonoperative therapy was observed in 114 patients (27%). Negative prognostic factors were bilateral occurrence of calcific tendinitis of the shoulder, localization to the anterior portion of the acromion, medial (subacromial) extension, and high volume of the calcific deposit. Positive prognostic factors were a Gärtner type III deposit and a lack of sonographic sound extinction of the calcific deposit.
Our findings demonstrate the existence of prognostic factors in the nonoperative treatment of chronic symptomatic calcific tendinitis of the shoulder. Guidelines for optimal treatment can be implemented according to these factors to avoid a long-term symptomatic disease course.
确定慢性症状性肩部钙化性肌腱炎患者的预后因素。
在一项前瞻性队列研究中，我们评估了420例患者（488个肩部）。评估了流行病学数据。对钙化沉积物的影像学和超声表现进行了分类。非手术治疗的平均时间为4.4年（范围0.5 - 13.7年）。转诊至我们机构后，标准化非手术治疗至少持续3个月。非手术治疗失败定义为至少6个月后肩部症状性钙化性肌腱炎持续存在。通过逻辑回归分析预后因素（经卡方检验确定P < 0.05）。
420例患者中，269例（64%）为女性，151例（36%）为男性。患者的平均年龄为51.3岁（范围28 - 84岁）。肩部钙化性肌腱炎单侧发生的占84%，双侧发生的占16%。发现37%为Gärtner I型钙化沉积物，32%为II型，31%为III型。114例患者（27%）观察到非手术治疗失败。阴性预后因素为肩部钙化性肌腱炎双侧发生、位于肩峰前部、内侧（肩峰下）延伸以及钙化沉积物体积大。阳性预后因素为Gärtner III型沉积物以及钙化沉积物无超声声影消失。
我们的研究结果表明，在肩部慢性症状性钙化性肌腱炎的非手术治疗中存在预后因素。可根据这些因素实施最佳治疗指南，以避免疾病长期出现症状。
