Bazzocchi Alberto, Pelotti Patrizia, Serraino Salvatore, Battaglia Milva, Bettelli Graziano, Fusaro Isabella, Guglielmi Giuseppe, Rotini Roberto, Albisinni Ugo
1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
2 Shoulder and Elbow Surgery Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
Br J Radiol. 2016;89(1057):20150407. doi: 10.1259/bjr.20150407. Epub 2015 Nov 26.
Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month.
A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month.
In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis.
The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults.
Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).
肩袖钙化性肌腱炎（RCCT）是成人肩部疼痛的常见原因，通常表现为与活动相关的肩部疼痛。在非手术和手术治疗方案中，如今有一些微创技术可用于清除钙化沉积物，它们是这种疼痛性临床病症治疗的基石。本研究的目的是对双针超声引导下经皮碎裂与灌洗术（DNL）进行回顾性评估，重点是了解在1个月时决定快速且良好反应的重要因素。
对147例适合DNL的RCCT患者进行评估。对单中心治疗的144例肩部进行了系统的病史、临床和影像学资料回顾。复查临床报告和影像学检查。纳入标准为接受DNL治疗，即适合经皮手术，并进行1个月的随访。不存在因偏倚风险而排除的情况。若1个月时Constant肩关节改良评分（CSS）改善>50%，则将治疗定义为成功。
70%的肩部治疗后症状迅速且显著减轻（成功）。总体而言，1个月时CSS增加估计为91.5±69.1%。CSS变化与患者年龄（30至40岁效果更佳）、钙化大小（中等大小钙化，12 - 17毫米改善更明显）、钙化沉积物的超声和放射学特征（较软的钙化）以及肩峰下/三角肌下滑囊壁增厚显著相关。在CSS变化的逐步回归最终模型中，治疗前和治疗后的超声评分、治疗前滑囊与钙化之间的距离以及治疗后钙化区域的大小与成功独立相关。疼痛数字评定量表评分显示了类似结果。入院时的疼痛也与年龄、钙化大小、超声和Gärtner评分、能量多普勒阳性、滑囊壁增厚以及肱二头肌腱鞘炎有关。
对于年轻成人的软质和中等大小钙化，该手术能快速改善功能和症状，取得成功。
超声引导下RCCT的经皮手术必须安全、有效，能迅速缓解疼痛并恢复功能。本研究表明哪种临床情况更有利于此目的以及DNL的实际预后因素（年轻成人的软质和中等大小钙化更有利）。
