Furuhata Ryogo, Matsumura Noboru, Oki Satoshi, Kimura Hiroo, Suzuki Taku, Iwamoto Takuji, Matsumoto Morio, Nakamura Masaya
Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan.
Orthop J Sports Med. 2022 Jan 21;10(1):23259671211071077. doi: 10.1177/23259671211071077. eCollection 2022 Jan.
Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown.
To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses.
Case-control study; Level of evidence, 3.
The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion.
Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; = .044) were significantly associated with loss of ER.
In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
巨大肩袖撕裂患者常出现肩关节主动活动范围丧失，这会干扰日常生活活动。运动丧失的危险因素在很大程度上尚不清楚。
通过多因素分析阐明影响慢性巨大肩袖撕裂患者运动范围的预测因素。
病例对照研究；证据等级，3级。
作者回顾性分析了在其机构接受评估的204例连续的慢性巨大肩袖撕裂患者。在本研究中，因变量被确定为主动前屈上举受限≤90°或上肢位于身体一侧时外旋（ER）受限≤0°。解释变量包括年龄、性别、患侧、症状持续时间、吸烟史、是否存在糖尿病、高血压或类风湿关节炎、受累肌腱、是否存在三肌腱撕裂、肱二头肌长头肌腱断裂、肱骨头向上移位以及肩袖撕裂性关节病。在单因素分析中观察到具有显著意义的基线变量被纳入多因素模型，该模型使用逻辑回归来确定运动丧失的独立预测因素。
总体而言，73例患者（35.8%）表现为前屈上举受限，27例（13.2%）表现为外旋受限。多因素分析显示，肩胛下肌下部撕裂（比值比[OR]，14.66；95%可信区间，2.95 - 72.93；P = 0.001）、吸烟（OR，4.13；95%可信区间，1.94 - 8.79；P < 0.001）、肱骨头向上移位（OR，3.92；95%可信区间，1.80 - 8.53；P = 0.001）和三肌腱撕裂（OR，3.29；95%可信区间，1.32 - 8.20；P = 0.011）与前屈上举丧失显著相关。小圆肌撕裂（OR，73.37；95%可信区间，9.54 - 564.28；P < 0.001）和肱骨头向上移位（OR，3.55；95%可信区间，,1.04 - 12.19；P = 0.044）与外旋丧失显著相关。
在本研究中，吸烟史、撕裂肌腱的类型以及肱骨头向上移位与肩关节主动运动丧失有关。特别是，肩胛下肌下部或小圆肌的状态促成了巨大肩袖撕裂中假性麻痹的发生。
