O'Malley Michael P, Kia Cameron, Dukas Alex G, Cote Mark, Stock Harlan, Savoy Lawrence, Tinsley Brian A, Alaee Farhang, Mazzocca Augustus D, Shea Kevin P
Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT, USA.
J Shoulder Elb Arthroplast. 2019 Feb 25;3:2471549219832442. doi: 10.1177/2471549219832442. eCollection 2019.
The subscapularis tendon is commonly released during shoulder arthroplasty, and its integrity and repair postoperatively have been shown important to help maximize patient function. However, diagnosing subscapular tendon failure can be difficult with magnetic resonance imaging secondary to metal artifact as well as very costly.
The purpose of this study was to assess the utility of ultrasound imaging in evaluating subscapularis integrity at specific time points following shoulder arthroplasty, in a blinded fashion. Secondarily, we report on the correlation between the condition of the subscapularis and quality-of-life outcome measures.
Prospective case series.
Ultrasounds were completed preoperatively and postoperatively at 1 week as well as at 1, 3, and 6 months. Each was read by a single musculoskeletal radiologist and categorized as "intact," "torn," or "unclear." Clinical outcome was evaluated using the Western Ontario Osteoarthritis Shoulder (WOOS) index at these same time points.
The final study group consisted of 35 procedures in 33 patients (19 females and 14 males, mean age 66 ± 9 years). Three patients had postoperative subscapularis failures that were confirmed in the operating room at the time of repair. Of 24 sonographs categorized as "unclear" in the postoperative period, the majority (n = 12, 50%) were taken at 1 week. Compared to preoperative scores, patients had lower WOOS scores at 1, 3, and 6 months postoperatively ( < .001). Correlation analysis did not reveal an association between the ultrasound readings and the WOOS scores postoperatively.
The utility of ultrasound examination of the subscapularis tendon following shoulder arthroplasty is limited by timing and may be most useful when used by the physician within clinical context. Significant improvement was noted in disease-specific quality-of-life scores regardless of the status of the subscapularis tendon as read on ultrasound.
在肩关节置换术中，肩胛下肌腱常被松解，其完整性及术后修复对患者功能最大化至关重要。然而，由于金属伪影，磁共振成像诊断肩胛下肌腱断裂困难且成本高昂。
本研究旨在以盲法评估超声成像在肩关节置换术后特定时间点评估肩胛下肌完整性的效用。其次，我们报告肩胛下肌状况与生活质量结局指标之间的相关性。
前瞻性病例系列研究。
术前、术后1周以及术后1、3和6个月进行超声检查。每次检查由一名肌肉骨骼放射科医生解读，并分类为“完整”“撕裂”或“不明确”。在相同时间点使用西安大略肩关节炎指数（WOOS）评估临床结局。
最终研究组包括33例患者的35例手术（19例女性和14例男性，平均年龄66±9岁）。3例患者术后肩胛下肌出现断裂，在修复手术时在手术室得到证实。术后24份超声检查报告分类为“不明确”，其中大多数（n = 12，50%）在术后1周获取。与术前评分相比，患者术后1、3和6个月的WOOS评分较低（P <.001）。相关性分析未显示术后超声检查结果与WOOS评分之间存在关联。
肩关节置换术后肩胛下肌腱超声检查的效用受时间限制，医生在临床环境中使用时可能最有用。无论超声检查显示肩胛下肌腱状况如何，疾病特异性生活质量评分均有显著改善。
