Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea.
Am J Sports Med. 2011 Oct;39(10):2099-107. doi: 10.1177/0363546511415659. Epub 2011 Aug 3.
The prognostic factors associated with structural outcome after arthroscopic rotator cuff repair have not yet been fully determined.
The hypothesis of this study was that bone mineral density (BMD) is an important prognostic factor affecting rotator cuff healing after arthroscopic cuff repair.
Cohort study; Level of evidence, 3.
Among 408 patients who underwent arthroscopic repair for full-thickness rotator cuff tear between January 2004 and July 2008, 272 patients were included whose postoperative cuff integrity was verified by computed tomography arthrography (CTA) or ultrasonography (USG) and simultaneously who were evaluated by various functional outcome instruments. The mean age at the time of operation was 59.5 ± 7.9 years. Postoperative CTA or USG was performed at a mean 13.0 ± 5.1 months after surgery, and the mean follow-up period was 37.2 ± 10.0 months (range, 24-65 months). The clinical, structural, and surgery-related factors affecting cuff integrity including BMD were analyzed using both univariate and multivariate analysis. Evaluation of postoperative cuff integrity was performed by musculoskeletal radiologists who were unaware of the present study.
The failure rate of rotator cuff healing was 22.8% (62 of 272). The failure rate was significantly higher in patients with lower BMD (P < .001); older age (P < .001); female gender (P = .03); larger tear size (P < .001); higher grade of fatty infiltration (FI) of the supraspinatus, infraspinatus, and subscapularis (all P < .001); diabetes mellitus (P = .02); shorter acromiohumeral distance (P < .001); and associated biceps procedure (P < .001). However, in the multivariate analysis, only BMD (P = .001), FI of the infraspinatus (P = .01), and the amount of retraction (P = .03) showed a significant relationship with cuff healing failure following arthroscopic rotator cuff repair.
Bone mineral density, as well as FI of the infraspinatus and amount of retraction, was an independent determining factor affecting postoperative rotator cuff healing. Further studies with prospective, randomized, and controlled design are needed to confirm the relationship between BMD and postoperative rotator cuff healing.
与关节镜肩袖修复后结构结果相关的预后因素尚未完全确定。
本研究的假设是骨密度（BMD）是影响关节镜肩袖修复后肩袖愈合的重要预后因素。
队列研究；证据水平，3 级。
在 2004 年 1 月至 2008 年 7 月期间接受关节镜全层肩袖撕裂修复的 408 例患者中，纳入了 272 例术后通过计算机断层扫描关节造影（CTA）或超声（USG）证实肩袖完整性，同时通过各种功能结果评估工具进行评估的患者。手术时的平均年龄为 59.5 ± 7.9 岁。术后 CTA 或 USG 在术后平均 13.0 ± 5.1 个月进行，平均随访时间为 37.2 ± 10.0 个月（范围，24-65 个月）。使用单变量和多变量分析分析了影响肩袖完整性的临床、结构和手术相关因素，包括 BMD。术后肩袖完整性的评估由不知道本研究的肌肉骨骼放射科医生进行。
肩袖愈合失败率为 22.8%（272 例中有 62 例）。BMD 较低的患者（P <.001）；年龄较大（P <.001）；女性（P =.03）；更大的撕裂尺寸（P <.001）；肩袖上、下和肩胛下肌的脂肪浸润（FI）程度较高（均 P <.001）；糖尿病（P =.02）；肩峰肱骨头距离较短（P <.001）；以及合并肱二头肌手术（P <.001）。然而，在多变量分析中，只有 BMD（P =.001）、冈下肌 FI（P =.01）和回缩量（P =.03）与关节镜肩袖修复后肩袖愈合失败有显著关系。
骨密度以及冈下肌 FI 和回缩量是影响术后肩袖愈合的独立决定因素。需要进一步进行前瞻性、随机和对照设计的研究以确认 BMD 与术后肩袖愈合之间的关系。
