Department of Orthopaedics & Traumatology Surgery, Hospital ASEPEYO Sant Cugat, Sant Cugat del Vallès, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain.
Department of Orthopaedics & Traumatology Surgery, Hospital Nacional de San Marcos-Guatemala, Guatemala.
J Shoulder Elbow Surg. 2021 Jan;30(1):27-33. doi: 10.1016/j.jse.2020.05.010. Epub 2020 Jun 9.
Factors affecting a rotator cuff symptomatic retear after arthroscopic repair have yet to be clearly identified, since they usually influence the surgical decisions.
Consecutive patients with full-thickness tear of the supraspinatus who underwent arthroscopic repair were retrospectively analyzed. Cases of symptomatic retear, defined as Sugaya type IV and V on magnetic resonance imaging, associated with intensive pain and/or functional impairment were identified at follow-up. The patients with no symptomatic retear were selected as the control group. Information from potential risk factors of symptomatic retear, including depression and subacromial corticosteroid injections, was extracted from the medical records. The statistical analysis included multivariant logistic regression.
The symptomatic retear rate was 9.5% in 158 patients. Patients in the symptomatic retear group were more likely to be smoking, to have massive tears, a short acromiohumeral distance, and moderate to severe fatty infiltration. They also had had more frequently subacromial corticosteroid injections and depression. However, following the multiple logistic regression analysis, only massive tears and moderate to severe fatty infiltration remained significantly associated. Similarly, in relation to the study hypothesis, both corticosteroid injections (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.49, 29.81; P = .013) and depression (OR 8.26, IC 1.04, 65.62; P = .046) were significantly associated with symptomatic retear risk.
This study found support for the hypothesis that both depression and corticosteroid infiltration before surgery are independent risk factors for symptomatic retear after arthroscopic repair of rotator cuff.
影响关节镜修复后肩袖症状性再撕裂的因素尚不清楚，因为这些因素通常会影响手术决策。
回顾性分析连续接受全层肩袖撕裂关节镜修复的患者。在随访中，根据磁共振成像（MRI）上的 Sugaya 分型 IV 和 V 确定有症状性再撕裂的病例，这些病例伴有剧烈疼痛和/或功能障碍。选择无症状性再撕裂的患者作为对照组。从病历中提取与症状性再撕裂相关的潜在危险因素（包括抑郁和肩峰下皮质类固醇注射）的信息。统计分析包括多变量逻辑回归。
158 例患者中症状性再撕裂率为 9.5%。症状性再撕裂组患者更可能吸烟、有巨大撕裂、肩峰肱骨头间距短、中重度脂肪浸润。他们也更频繁地接受肩峰下皮质类固醇注射和抑郁治疗。然而，在多变量逻辑回归分析后，只有巨大撕裂和中重度脂肪浸润仍然与症状性再撕裂显著相关。同样，根据研究假设，皮质类固醇注射（比值比 [OR] 6.66，95%置信区间 [CI] 1.49，29.81；P =.013）和抑郁（OR 8.26，CI 1.04，65.62；P =.046）均与症状性再撕裂风险显著相关。
本研究支持这样一种假设，即术前的抑郁和皮质类固醇浸润均是关节镜修复肩袖后症状性再撕裂的独立危险因素。
