Park Joo Hyun, Lee Kwang Yeol, Rhee Sung Min, Oh Joo Han
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Orthopaedic Surgery, Mega Hospital, Gimhae, Korea.
Clin Shoulder Elb. 2018 Jun 1;21(2):67-74. doi: 10.5397/cise.2018.21.2.67. eCollection 2018 Jun.
Fatty degeneration of rotator cuff is a well-known predictor of postoperative outcome. The purpose of this study was to evaluate the clinical features of rotator cuff tears involving subscapularis, and investigate whether fatty degeneration quantified from only the upper subscapularis correlates better with clinical outcomes than quantified from the whole subscapularis.
We retrospectively analyzed 315 consecutive patients who underwent arthroscopic repair for rotator cuff tears involving subscapularis with a minimum follow-up of 1 year. Preoperative and postoperative visual analogue score for pain, range of motion and functional scores were assessed. Integrity of the repaired tendon was assessed at the 1-year follow-up with either magnetic resonance imaging or ultrasonography.
The mean Goutallier grade of whole cross-section was significantly lower than that of upper cross-section (1.59 vs. 1.71, <0.05), but significantly higher than that of lower cross-section (1.59 vs. 1.01, <0.05). In analysis of 37 re-tears, the occupancy of severe fatty degeneration in upper cross-section was 86.5%, which was significantly higher than that seen in whole cross-section (56.8%, <0.05). We calculated the cut-off tear size for prediction of re-tears as 19.0 mm for retraction and 11.0 mm for superior-inferior. The cut-off Goutallier grade was 2.5 for both whole and upper cross-sections, but area under the curve was greater in the upper cross-section than the whole (0.911 vs. 0.807).
As fatty degeneration of upper subscapularis demonstrated a more distinct spectrum than whole subscapularis, we suggest that measuring fatty degeneration of upper subscapularis can be a more useful method to predict clinical prognosis.
肩袖脂肪变性是术后结果的一个众所周知的预测指标。本研究的目的是评估累及肩胛下肌的肩袖撕裂的临床特征，并调查仅从肩胛下肌上部量化的脂肪变性与临床结果的相关性是否优于从整个肩胛下肌量化的脂肪变性。
我们回顾性分析了315例连续接受关节镜修复累及肩胛下肌的肩袖撕裂的患者，最短随访1年。评估术前和术后疼痛视觉模拟评分、活动范围和功能评分。在1年随访时通过磁共振成像或超声评估修复肌腱的完整性。
整个横截面的平均Goutallier分级显著低于上部横截面（1.59对1.71，<0.05），但显著高于下部横截面（1.59对1.01，<0.05）。在分析37例再次撕裂时，上部横截面严重脂肪变性的占比为86.5%，显著高于整个横截面（56.8%，<0.05）。我们计算出预测再次撕裂的撕裂大小临界值，回缩为19.0毫米，上下径为11.0毫米。整个横截面和上部横截面的Goutallier分级临界值均为2.5，但上部横截面的曲线下面积大于整个横截面（0.911对0.807）。
由于肩胛下肌上部的脂肪变性比整个肩胛下肌表现出更明显的特征谱，我们建议测量肩胛下肌上部的脂肪变性可能是预测临床预后更有用的方法。
