Yamamoto Nobuyuki, Mineta Mitsuyoshi, Kawakami Jun, Sano Hirotaka, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
Department of Orthopaedic Surgery, Sendai City Hospital, Sendai, Japan.
Am J Sports Med. 2017 Sep;45(11):2524-2531. doi: 10.1177/0363546517709780. Epub 2017 Jun 13.
The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen.
Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers.
Case-control study; Level of evidence, 3.
Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness).
Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any correlation with tear progression.
The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/y in length and 2.0 mm/y in width. The risk factors for tear progression were (1) a medium-sized tear, (2) a full-thickness tear, and (3) smoking.
有症状的肩袖撕裂进展的危险因素尚未明确。对于骨科医生而言，在选择非手术治疗时了解撕裂进展的自然病程很重要。
年轻患者、高活动量患者或重体力劳动者的撕裂在大小上的进展要比老年患者、低活动量患者或轻体力劳动者的撕裂更大。
病例对照研究；证据等级，3级。
2009年至2015年期间，连续有225例有症状的肩袖撕裂患者前来我院就诊。其中，对171例患者（平均年龄66.9岁）的174个肩部进行了至少2次磁共振成像（MRI）检查，并进行前瞻性纳入研究。平均随访时间为19个月。当撕裂大小增加≥2mm时，撕裂进展被定义为阳性。通过多变量分析的人口统计学因素包括年龄、性别、利手、吸烟、饮酒、高胆固醇血症、运动参与情况、工作类型、撕裂大小和撕裂类型（全层或部分厚度）。
在174个肩部中，82个肩部（47%）出现了撕裂进展。最终MRI上进展组的平均（±标准差）撕裂长度和宽度分别为23.1±12.5mm和17.3±9.6mm；撕裂大小在长度上平均进展5.8±5.6mm，在宽度上平均进展3.1±5.2mm。平均进展速度在长度上为3.8mm/年，在宽度上为2.0mm/年。与关节侧部分厚度撕裂相比，全层撕裂的大小显著增加（P = 0.0215）。中等大小撕裂的大小与其他撕裂相比显著增加（P < 0.0001）。根据逻辑回归分析，吸烟与撕裂进展显著相关（P = 0.026）。亚组分析显示，男性、利手和创伤与撕裂进展相关。年龄、饮酒、高胆固醇血症、运动参与情况和工作类型与撕裂进展无任何相关性。
有症状的肩袖撕裂在平均19个月的时间里，47%的肩部撕裂大小出现进展，进展速度在长度上为3.8mm/年，在宽度上为2.0mm/年。撕裂进展的危险因素为：（1）中等大小的撕裂；（2）全层撕裂；（3）吸烟。
