Kvalvaag Elisabeth, Anvar Masoud, Karlberg Anna Cecilia, Brox Jens Ivar, Engebretsen Kaia Beck, Soberg Helene Lundgaard, Juel Niels Gunnar, Bautz-Holter Erik, Sandvik Leiv, Roe Cecilie
Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway.
University of Oslo, Medical Faculty, Boks 1072 Blindern, 0316, Oslo, Norway.
BMC Musculoskelet Disord. 2017 Nov 21;18(1):469. doi: 10.1186/s12891-017-1827-3.
Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)).
A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up.
There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = -3.1, with 95% CI -5.9 to -0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to -3.8; p < 0.001), with a poorer outcome for patients with a higher MRI total score. Both tendinosis (p = 0.01) and bursitis (p = 0.04) were associated with a poorer outcome after one year.
In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI.
Clinicaltrials.gov no NCT01441830 . September 28, 2011.
既往针对肩部疾病患者的研究表明，肩袖或滑囊异常的患病率与症状的相关性较弱，且在无症状人群中也常发现类似结果。此外，磁共振成像（MRI）所识别的结构变化是否会影响肩痛治疗后的预后，目前很大程度上尚不清楚。因此，本研究的目的是评估肩峰下疼痛综合征患者MRI上结构变化的存在情况，并确定这些变化与症状的关联程度以及预测治疗后的预后（通过肩痛和功能障碍指数（SPADI）进行评估）。
对纳入一项随机研究的一部分肩部疾病患者进行前瞻性观察评估。所有参与者均接受了肩部MRI检查。计算了AC关节、肩峰下滑囊和肩袖处MRI检查结果的总分。应用多元线性回归分析来检验基线时MRI总分与预后指标之间的关系，并检验MRI总分在多大程度上与从基线到一年随访期间SPADI评分的变化相关。
基线时SPADI评分与MRI总分之间存在微弱的负相关（β = -3.1，95%置信区间为 -5.9至 -0.34；p = 0.03），即MRI总分较低的患者SPADI评分较高。从基线到一年随访期间SPADI评分的变化与MRI总分之间存在关联（β = 8.1，95%置信区间为 -12.3至 -3.8；p < 0.001），MRI总分较高的患者预后较差。肌腱病（p = 0.01）和滑囊炎（p = 0.04）均与一年后的预后较差相关。
在本研究中，MRI检查结果与从基线到一年随访期间SPADI评分的变化显著相关，MRI总分较高、存在肌腱病和滑囊炎的患者治疗后预后较差。
Clinicaltrials.gov，编号NCT01441830。2011年9月28日。
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