Centre Orthopédique Santy, Lyon, France.
Clin Orthop Relat Res. 2010 Jun;468(6):1498-505. doi: 10.1007/s11999-009-1207-x.
In some patients nonoperative treatment of a rotator cuff tear is sufficient, while in others it is only the first stage of treatment prior to surgery. Fatty infiltration progresses throughout the nonoperative treatment although it is not known at what point fatty infiltration contributes to poor functional outcomes, absence of healing, or increased rerupture rates.
QUESTIONS/PURPOSES: We therefore identified factors related to the appearance of supraspinatus muscle fatty infiltration, determined the speed of appearance and progression of this phenomenon, and correlated fatty infiltration with muscular atrophy.
We retrospectively reviewed 1688 patients with rotator cuff tears and recorded the following: number of tendons torn, etiology of the tear, time between onset of shoulder symptoms and diagnosis of rotator cuff tear. Fatty infiltration of the supraspinatus was graded using either CT or MRI classification. Muscular atrophy was measured indirectly using the tangent sign.
Moderate supraspinatus fatty infiltration appeared an average of 3 years after onset of symptoms and severe fatty infiltration at an average of 5 years after the onset of symptoms. A positive tangent sign appeared at an average of 4.5 years after the onset of symptoms.
Our results suggest that rotator cuff repair should be performed before the appearance of fatty infiltration (Stage 2) and atrophy (positive tangent sign)-especially when the tear involves multiple tendons.
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
在一些患者中，肩袖撕裂的非手术治疗已足够，而在另一些患者中，这只是手术前的第一阶段治疗。尽管目前尚不清楚脂肪浸润在何时会导致功能预后不良、愈合缺失或增加再撕裂率，但在非手术治疗过程中，脂肪浸润会不断进展。
问题/目的：因此，我们确定了与冈上肌脂肪浸润出现相关的因素，确定了这种现象的出现和进展速度，并将脂肪浸润与肌肉萎缩相关联。
我们回顾性分析了 1688 例肩袖撕裂患者的资料，记录了以下内容：撕裂的肌腱数量、撕裂的病因、肩痛症状出现到肩袖撕裂诊断的时间。使用 CT 或 MRI 分级法对冈上肌脂肪浸润进行分级。使用切线征间接测量肌肉萎缩。
中度冈上肌脂肪浸润平均在症状出现后 3 年出现，重度脂肪浸润平均在症状出现后 5 年出现。切线征阳性平均在症状出现后 4.5 年出现。
我们的研究结果表明，肩袖修复应在脂肪浸润（第 2 期）和萎缩（切线征阳性）出现之前进行，尤其是当撕裂累及多个肌腱时。
IV 级，预后研究。有关证据水平的完整描述，请参见作者指南。
