Department of Medical Imaging, University of Crete, University Hospital of Heraklion, Voutes 71110, Heraklion, Crete, Greece.
Department of Medical Imaging, General Hospital of Sitia, Sitia, Crete, Greece.
Eur Radiol. 2021 Apr;31(4):2634-2643. doi: 10.1007/s00330-020-07334-2. Epub 2020 Oct 10.
To identify prognostic factors affecting the clinical outcome in patients treated with rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), by evaluating the degree of calcium removal, the size and consistency of calcific deposits, and baseline level of shoulder pain and functionality.
From January 2017 to December 2019, 79 patients (23 males, 56 females; mean age, 45.7 years) who underwent US-PICT were prospectively enrolled. The calcifications' location, consistency, and size were evaluated. For US-PICT, local anesthesia, lavage of calcific material, and intrabursal steroid injection were performed. The degree of calcium removal was graded as total/partial. Shoulder pain and functionality were assessed with the visual analogue scale (VAS) in all and Constant score (CS) in a subset of patients, respectively, at 4 time-points. Mann-Whitney U test, Fisher's test, and linear and binary logistic regression were utilized for analysis.
Pain improvement correlated with the presence of larger calcifications and lower baseline VAS score, at 1 week (p = 0.001, p < 0.001, respectively) and 1 year (p < 0.001, p = 0.002, respectively). Improved functionality correlated with total calcification retrieval, higher baseline CS, and fluid/soft calcific consistency at 1 week (p = 0.013, p = 0.003, p = 0.019, respectively). Increased calcification size, cystic appearance, and lower baseline VAS scores independently predicted complete pain resolution at 1 year.
Large calcifications and low-grade pain at baseline correlated with short- and long-term pain improvement. The degree of calcium removal did not impact pain or functional improvement beyond 1 week. Increased calcification size, cystic appearance, and low-grade baseline pain predicted complete pain recovery at 1 year.
• The presence of larger calcifications and lower-grade baseline pain appear to correlate with pain improvement at 1 week and 1 year after ultrasound-guided irrigation of rotator cuff calcific tendinopathy (US-PICT). • Total calcification retrieval, less affected baseline shoulder functionality, and presence of fluid/soft consistency of calcific deposits appear to correlate with improved shoulder functionality at 1 week post-treatment. • Baseline pain intensity and calcifications' morphologic characteristics, but not the degree of calcium retrieval, represent predictors of complete pain recovery at 1 year after US-PICT.
通过评估钙去除程度、钙化沉积物的大小和一致性以及肩部疼痛和功能的基线水平，确定影响接受肩袖超声引导经皮灌洗钙化性肌腱病（US-PICT）治疗的患者临床结果的预后因素。
2017 年 1 月至 2019 年 12 月，前瞻性纳入 79 例接受 US-PICT 的患者（男 23 例，女 56 例；平均年龄 45.7 岁）。评估钙化的位置、一致性和大小。行 US-PICT 时，行局部麻醉、冲洗钙化物质和囊内类固醇注射。钙去除程度分级为完全/部分。所有患者均采用视觉模拟评分（VAS）评估肩部疼痛和功能，部分患者采用 Constant 评分（CS）评估肩部功能，分别在 4 个时间点进行评估。采用 Mann-Whitney U 检验、Fisher 检验、线性和二项逻辑回归进行分析。
1 周（p=0.001，p<0.001）和 1 年（p<0.001，p=0.002）时，疼痛改善与较大的钙化和较低的基线 VAS 评分相关。1 周时（p=0.013，p=0.003，p=0.019）和 1 年时（p=0.013，p=0.003，p=0.019），功能改善与完全钙化去除、较高的基线 CS 和液体/软钙化一致性相关。1 年时，钙化增大、囊性外观和较低的基线 VAS 评分独立预测完全疼痛缓解。
基线时较大的钙化和低级别疼痛与短期和长期疼痛改善相关。1 周后，钙去除程度对疼痛或功能改善无影响。1 年时，钙化增大、囊性外观和低级别基线疼痛预测完全疼痛恢复。
较大的钙化和较低的基线疼痛似乎与超声引导肩袖钙化性肌腱病（US-PICT）灌洗后 1 周和 1 年的疼痛改善相关。
完全钙化去除、较少受影响的基线肩部功能以及钙化沉积物的液体/软一致性似乎与治疗后 1 周时肩部功能的改善相关。
基线疼痛强度和钙化的形态特征，但不是钙去除程度，是 US-PICT 后 1 年完全疼痛缓解的预测因素。
