Centre of Shoulder Surgery, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ward, Nagoya, Aichi, 467-8601, Japan.
Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):161-168. doi: 10.1007/s00167-017-4608-5. Epub 2017 Jun 22.
Magnetic resonance (MR) imaging is common in structural and qualitative assessment of the rotator cuff post-operatively. Rotator cuff integrity has been thought to be associated with clinical outcome. The purpose of this study was to evaluate the inter-observer reliability of cuff integrity (Sugaya's classification) and assess the correlation between Sugaya's classification and the clinical outcome. It was hypothesized that Sugaya's classification would show good reliability and good correlation with the clinical outcome.
Post-operative MR images were taken two years post-operatively, following arthroscopic rotator cuff repair. For assessment of inter-rater reliability, all radiographic evaluations for the supraspinatus muscle were done by two orthopaedic surgeons and one radiologist. Rotator cuff integrity was classified into five categories, according to Sugaya's classification. Fatty infiltration was graded into four categories, based on the Fuchs' classification grading system. Muscle hypotrophy was graded as four grades, according to the scale proposed by Warner. The clinical outcome was assessed according to the constant scoring system pre-operatively and 2 years post-operatively.
Of the sixty-two consecutive patients with full-thickness rotator cuff tears, fifty-two patients were reviewed in this study. These subjects included twenty-three men and twenty-nine women, with an average age of fifty-seven years. In terms of the inter-rater reliability between orthopaedic surgeons, Sugaya's classification showed the highest agreement [ICC (2.1) = 0.82] for rotator cuff integrity. The grade of fatty infiltration and muscle atrophy demonstrated good agreement, respectively (0.722 and 0.758). With regard to the inter-rater reliability between orthopaedic surgeon and radiologist, Sugaya's classification showed good reliability [ICC (2.1) = 0.70]. On the other hand, fatty infiltration and muscle hypotrophy classifications demonstrated fair and moderate agreement [ICC (2.1) = 0.39 and 0.49]. Although no significant correlation was found between overall post-operative constant score and Sugaya's classification, Sugaya's classification indicated significant correlation with the muscle strength score.
Sugaya's classification showed repeatability and good agreement between the orthopaedist and radiologist, who are involved in the patient care for the rotator cuff tear. Common classification of rotator cuff integrity with good reliability will give appropriate information for clinicians to improve the patient care of the rotator cuff tear. This classification also would be helpful to predict the strength of arm abduction in the scapular plane.
IV.
磁共振（MR）成像常用于术后肩袖结构和定性评估。肩袖完整性被认为与临床结果相关。本研究的目的是评估肩袖完整性（Sugaya 分类）的观察者间可靠性，并评估 Sugaya 分类与临床结果之间的相关性。假设 Sugaya 分类将显示出良好的可靠性和与临床结果的良好相关性。
在关节镜下肩袖修复术后两年，进行术后磁共振成像检查。为了评估观察者间的可靠性，两名骨科医生和一名放射科医生对所有冈上肌的影像学评估进行了评估。根据 Sugaya 分类，将肩袖完整性分为五类。根据 Fuchs 分类分级系统，将脂肪浸润分为四级。根据 Warner 提出的量表，将肌肉萎缩分为四级。根据术前和术后 2 年的 Constant 评分系统评估临床结果。
在 62 例全层肩袖撕裂的连续患者中，有 52 例患者进行了本研究。这些患者包括 23 名男性和 29 名女性，平均年龄为 57 岁。在骨科医生之间的观察者间可靠性方面，Sugaya 分类显示出最高的一致性[ICC（2.1）=0.82]，用于肩袖完整性。脂肪浸润和肌肉萎缩的分级分别显示出良好的一致性（分别为 0.722 和 0.758）。至于骨科医生和放射科医生之间的观察者间可靠性，Sugaya 分类显示出良好的可靠性[ICC（2.1）=0.70]。另一方面，脂肪浸润和肌肉萎缩分类显示出适度和中度一致性[ICC（2.1）=0.39 和 0.49]。尽管总体术后Constant 评分与 Sugaya 分类之间没有显著相关性，但 Sugaya 分类与肌肉力量评分显著相关。
Sugaya 分类在参与肩袖撕裂患者治疗的骨科医生和放射科医生之间具有可重复性和良好的一致性。共同的肩袖完整性分类具有良好的可靠性，将为临床医生提供改善肩袖撕裂患者护理的适当信息。这种分类也有助于预测肩胛骨平面上臂外展的力量。
IV。
