Nakamura Yoshihiro, Yokoya Shin, Harada Yohei, Shiraishi Katsunori, Adachi Nobuo, Ochi Mitsuo
Department of Orthopaedics, Hiroshima University, Hiroshima, Japan.
Department of Orthopaedics, Hiroshima University, Hiroshima, Japan.
J Orthop Sci. 2017 Jul;22(4):676-681. doi: 10.1016/j.jos.2017.02.008. Epub 2017 Mar 19.
The purpose of this study was to evaluate the relationship of fatty infiltration in rotator cuff muscles and shoulder strength in rotator cuff tears and these changes during nonsurgical treatment.
Fifty-three shoulders from 47 patients (mean age: 69.9 years) diagnosed with rotator cuff tears by magnetic resonance imaging (MRI) were treated nonsurgically. The degrees of fatty infiltration in supraspinatus (SSP) and infraspinatus (ISP) muscles were graded by the modified Goutallier classification (grade 0-1, grade 2-3, or grade 4). The isometric strength of the abductors (Abd) and external rotators (ER) were examined with a hand dynamometer. We analyzed the correlation of the modified Goutallier classification in SSP and ISP muscles with the strength of Abd and ER at initial visit. In addition, MRI and strength tests were repeated after 24 ± 6 months, and changes in fatty infiltration and strength were examined.
Fatty infiltration of SSP and ISP muscles had a negative correlation with the strengths of Abd and ER at initial visit, respectively. Six of 45 shoulders (SSP grade: 0-3) and 7 of 43 shoulders (ISP grade: 0-3) had progression of fatty infiltration. Predictive factor of a progression of fatty infiltration during follow-up was decreased initial strength of Abd. There was no significant change in the strength of Abd, and the strength of ER showed significant improvement between the initial and post-treatment measurements. Even in the subgroup that had progression of fatty infiltration at follow-up, the strength of Abd and ER did not decrease significantly.
Although fatty infiltration of the rotator cuff muscles exhibited a negative correlation with muscle strength, fatty infiltration and muscle weakness did not progress at the same rate.
本研究旨在评估肩袖撕裂患者肩袖肌肉脂肪浸润与肩部力量之间的关系，以及非手术治疗期间的这些变化。
对47例（平均年龄：69.9岁）经磁共振成像（MRI）诊断为肩袖撕裂的患者的53个肩部进行非手术治疗。采用改良的Goutallier分类法（0-1级、2-3级或4级）对冈上肌（SSP）和冈下肌（ISP）的脂肪浸润程度进行分级。使用手持测力计检查外展肌（Abd）和外旋肌（ER）的等长力量。我们分析了初次就诊时SSP和ISP肌肉改良Goutallier分类与Abd和ER力量之间的相关性。此外，在24±6个月后重复进行MRI和力量测试，并检查脂肪浸润和力量的变化。
初次就诊时，SSP和ISP肌肉的脂肪浸润分别与Abd和ER的力量呈负相关。45个肩部中有6个（SSP分级：0-3级）和43个肩部中有7个（ISP分级：0-3级）出现脂肪浸润进展。随访期间脂肪浸润进展的预测因素是Abd初始力量下降。Abd的力量没有显著变化，ER的力量在治疗前和治疗后的测量之间显示出显著改善。即使在随访时出现脂肪浸润进展的亚组中，Abd和ER的力量也没有显著下降。
虽然肩袖肌肉的脂肪浸润与肌肉力量呈负相关，但脂肪浸润和肌肉无力的进展速度并不相同。
