Pepke W, Brunner M, Abel R, Almansour H, Gerner H J, Hug A, Zeifang F, Kentar Y, Bruckner T, Akbar M
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200A, 69118, Heidelberg, Deutschland.
Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
Orthopade. 2018 Jul;47(7):561-566. doi: 10.1007/s00132-018-3546-3.
Shoulder pain and rotator cuff tears are highly prevalent among wheelchair dependent individuals with paraplegia. The purpose of this study was to identify potential risk factors associated with the development of rotator cuff tears in this population.
A total of 217 wheelchair dependent individuals with paraplegia were included in this cross-sectional study (level of evidence III). The mean age of this population was 47.9 years and the mean duration of wheelchair dependence was 24.1 years. Each individual was asked to complete a questionnaire designed to identify risk factors for rotator cuff tears and underwent a standardized clinical examination with the documentation of the Constant-Murley shoulder outcome score and magnetic resonance imaging (MRI) of both shoulder joints.
MRI analysis revealed at least one rotator cuff tear in 93 patients (43%). Multiple logistic regression analysis identified the following factors to be associated with the presence of rotator cuff tear: patient age, duration of spinal cord injury/wheelchair dependence, gender, and wheelchair athletic activity. Neither BMI nor the level of spinal cord injury was found to pose a risk factor in the population studied. With respect to patient age, the risk of developing a rotator cuff tear increased by 11% per annum. In terms of duration of spinal cord injury, the analysis revealed a 6% increased risk per year of wheelchair dependence (OR = 1.06). Females had a 2.6-fold higher risk of developing rotator cuff tears than males and wheelchair sport activity increased the risk 2.3-fold.
There is a high prevalence of rotator cuff tears in wheel-chair dependent persons with paraplegia. Risk factors such as age, gender, duration of paraplegia, and wheel chair sport activity seem to play an important role in the development of rotator cuff tears.
肩痛和肩袖撕裂在截瘫的轮椅依赖者中非常普遍。本研究的目的是确定该人群中与肩袖撕裂发生相关的潜在风险因素。
本横断面研究（证据级别III）纳入了总共217名截瘫的轮椅依赖者。该人群的平均年龄为47.9岁，平均轮椅依赖时间为24.1年。要求每个人完成一份旨在识别肩袖撕裂风险因素的问卷，并接受标准化临床检查，记录Constant-Murley肩关节结果评分以及双侧肩关节的磁共振成像（MRI）。
MRI分析显示93名患者（43%）至少有一处肩袖撕裂。多因素逻辑回归分析确定以下因素与肩袖撕裂的存在相关：患者年龄、脊髓损伤/轮椅依赖时间、性别和轮椅运动活动。在所研究的人群中，未发现BMI和脊髓损伤水平是风险因素。就患者年龄而言，发生肩袖撕裂的风险每年增加11%。就脊髓损伤时间而言，分析显示轮椅依赖每年的风险增加6%（比值比=1.06）。女性发生肩袖撕裂的风险是男性的2.6倍，轮椅运动活动使风险增加2.3倍。
截瘫的轮椅依赖者中肩袖撕裂的患病率很高。年龄、性别、截瘫时间和轮椅运动活动等风险因素似乎在肩袖撕裂的发生中起重要作用。
