Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
J Shoulder Elbow Surg. 2018 Jun;27(6):1004-1011. doi: 10.1016/j.jse.2017.12.002. Epub 2018 Feb 8.
We investigated the impact of poor seated posture on the prevalence of rotator cuff tears (RCTs) among wheelchair-dependent individuals with long-standing paraplegia.
The study included 319 patients. Lateral radiographs of the spine were collected from a database and analyzed to assess the global spinopelvic alignment (SPA). Magnetic resonance images of both shoulders were obtained to detect the presence of cuff tears. Patients were divided into 2 groups: Group RCT-I included all patients with cuff tears (right, left, or bilateral), whereas group RCT-II consisted exclusively of patients with bilateral cuff tears. We used the classification systems developed by Kendall et al and Roussouly et al to assess the sagittal spine alignment and SPA, respectively. Univariate and multivariate analyses were performed. To fit both models (groups RCT-I and RCT-II) to the data, the 4 spine curves according to Roussouly et al were subdivided into 2 groups: Group SPA-I included both type 1 and type 2, whereas group SPA-II included both type 3 and type 4.
Magnetic resonance images showed a cuff tear in 192 patients (60.19%) (group RCT-I). Among those, 37 patients (11.60%) had tears in both shoulders (group RCT-II). In group RCT-I, 70.31% of the patients had a kyphotic-lordotic posture. The kyphotic-lordotic posture, a longer duration, and a more rostral neurologic level of injury were highly associated with cuff tear prevalence. In group RCT-II, the multivariate analysis showed that only the duration of spinal cord injury was significantly associated with RCTs.
Thoracic hyperkyphosis was associated with a markedly high rate of RCTs. The data from this study may provide support for developing preventive strategies.
我们研究了长期截瘫的轮椅依赖患者不良坐姿对肩袖撕裂（RCT）发生率的影响。
这项研究纳入了 319 名患者。从数据库中收集脊柱侧位 X 光片，以评估整体脊柱骨盆矢状位（SPA）。获取双侧肩部的磁共振图像以检测肩袖撕裂的存在。患者分为 2 组：RCT-I 组包括所有有肩袖撕裂的患者（右侧、左侧或双侧），而 RCT-II 组仅包括双侧肩袖撕裂的患者。我们使用 Kendall 等人和 Roussouly 等人分别开发的分类系统评估矢状位脊柱排列和 SPA。进行单变量和多变量分析。为了使这两个模型（RCT-I 组和 RCT-II 组）适用于数据，根据 Roussouly 等人的 4 个脊柱曲线分为 2 组：SPA-I 组包括 1 型和 2 型，SPA-II 组包括 3 型和 4 型。
磁共振图像显示 192 名患者（60.19%）有肩袖撕裂（RCT-I 组）。其中，37 名患者（11.60%）双肩撕裂（RCT-II 组）。在 RCT-I 组中，70.31%的患者存在后凸前屈姿势。后凸前屈姿势、较长的病程和较高的神经根损伤水平与肩袖撕裂的发生率高度相关。在 RCT-II 组中，多变量分析显示，只有脊髓损伤的病程与 RCT 显著相关。
胸段脊柱过度后凸与肩袖撕裂的发生率显著相关。本研究的数据可能为制定预防策略提供支持。
