Oudelaar Bart W, Ooms Edwin M, Huis In 't Veld Rianne M H A, Schepers-Bok Relinde, Vochteloo Anne J
Centre for Orthopaedic Surgery OCON, Shoulder Unit, P.O. Box 546, 7550 AM, Hengelo, The Netherlands.
Department of Radiology, Department of radiology Hengelo, Ziekenhuisgroep Twente, P.O. Box 546, 7550 AM Hengelo, The Netherlands.
Eur J Radiol. 2015 Nov;84(11):2255-60. doi: 10.1016/j.ejrad.2015.07.030. Epub 2015 Jul 31.
Although NACD has proven to be an effective minimal invasive treatment for calcific tendinitis of the rotator cuff, little is known about the factors associated with treatment failure or the need for multiple procedures.
Patients with symptomatic calcific tendinitis who were treated by NACD were evaluated in a retrospective cohort study. Demographic details, medical history, sonographic and radiographic findings were collected from patient files. Failure of NACD was defined as the persistence of symptoms after a follow-up of at least six months. NACD procedures performed within six months after a previous NACD procedure were considered repeated procedures. Multivariate logistic regression analysis was used to determine factors associated with treatment failure and multiple procedures.
431 patients (277 female; mean age 51.4±9.9 years) were included. Smoking (adjusted odds ratio (AOR): 1.7, 95% CI 1.0-2.7, p=0.04) was significantly associated with failure of NACD. Patients with Gärtner and Heyer (GH) type I calcific deposits were more likely to need multiple NACD procedures (AOR: 3.4, 95% CI 1.6-7.5, p<0.01) compared to patients with type III calcific deposits. Partial thickness rotator cuff tears were of no influence on the outcome of NACD or the number of treatments necessary.
Smoking almost doubled the chance of failure of NACD and the presence of GH type I calcific deposits significantly increased the chance of multiple procedures. Partial thickness rotator cuff tears did not seem to affect the outcome of NACD. Based on the findings in this study, the importance of quitting smoking should be emphasized prior to NACD and partial thickness rotator cuff tears should not be a reason to withhold patients NACD.
尽管非手术关节镜下钙化切除术（NACD）已被证明是治疗肩袖钙化性肌腱炎的一种有效的微创手术，但对于与治疗失败或需要多次手术相关的因素知之甚少。
在一项回顾性队列研究中，对接受NACD治疗的有症状的钙化性肌腱炎患者进行了评估。从患者病历中收集人口统计学细节、病史、超声和影像学检查结果。NACD治疗失败定义为至少随访6个月后症状持续存在。在前一次NACD手术后6个月内进行的NACD手术被视为重复手术。采用多因素逻辑回归分析来确定与治疗失败和多次手术相关的因素。
纳入431例患者（277例女性；平均年龄51.4±9.9岁）。吸烟（调整后的优势比（AOR）：1.7，95%可信区间1.0 - 2.7，p = 0.04）与NACD治疗失败显著相关。与III型钙化沉积物患者相比，Gärtner和Heyer（GH）I型钙化沉积物患者更有可能需要多次NACD手术（AOR：3.4，95%可信区间1.6 - 7.5，p < 0.01）。肩袖部分厚度撕裂对NACD的治疗结果或所需治疗次数没有影响。
吸烟使NACD治疗失败的几率几乎增加了一倍，GH I型钙化沉积物的存在显著增加了多次手术的几率。肩袖部分厚度撕裂似乎不影响NACD的治疗结果。基于本研究的结果，在进行NACD之前应强调戒烟的重要性，肩袖部分厚度撕裂不应成为拒绝患者接受NACD治疗的理由。
