Chen Jun, Lou Yu-Xiang, Xu Guo-Hong, Wang Wei-Kai
Department of Joint and Sports Medicine, Dongyang People's Hospital, Dongyang 322100, Zhejiang, China.
Zhongguo Gu Shang. 2022 Mar 25;35(3):225-32. doi: 10.12200/j.issn.1003-0034.2022.03.006.
To investigate the correlation between serum vitamin D level and clinical outcomes after repair of rotator cuff tears.
A total 122 patients who met the inclusion criteria and were followed up for 12 months from March 2018 to March 2020 were analyzed retrospectively, including 50 males and 72 females with an average age of(62.10±8.39) years old (ranged, 34 to 82 years old). All patients were divided into deficiency group(vitamin D<20 μg/L) and control group(vitamin D≥20 μg/L), including 62 cases in the deficiency group, with vitamin D (14.80±3.18) μg/L;60 cases in the control group, with vitamin D(25.17±5.64) μg/L. The two groups were compared in terms of age, gender, body mass index(BMI), tear size, degree of retraction, degree of fatty infiltration, injury factors, postoperative pain VAS score, postoperative shoulder joint function score, and re-tear rate. The age of all patients was divided into two categories:<60 years old and ≥60 years old;BMI was divided into <24 kg/m and ≥ 24 kg/m;tear size was divided into ≤3 cm and >3 cm;retraction degree was divided into ≤2 cm and >2 cm;fat infiltration was divided into ≤2 grade and >2 grade;and the course of the disease was ≤3 months and >3 months. The correlation between Sugaya re-tear type and the variables listed above were analyzed and calculated.
There were no major complications such as joint infection, anchor withdrawal and revision surgery in any of the 122 patients who were followed up on. There were no statistical differences in age, gender, injury factor, BMI, tear size, degree of retraction, degree of fatty infiltration, and duration of disease between the two groups (>0.05). The Constant-Murley scores, UCLA scores, and ASES scores of the two groups all improved considerably after surgery(<0.05);however, there was no statistical differences in the postoperative shoulder function scores between the two groups (>0.05). There was significant difference in VAS between the two groups 1 month and 3 months after operation, with vitamin D deficiency group scoring higher, and there was no significant differences 6 and 12 months after operation. Tear size(>3 cm), degree of retraction(>2 cm), degree of fatty infiltration(>2 degree) were all shown to be the independent risk factors for retear after surgery by Logistic regression analysis(<0.05). The comparison between the two groups of patients using a 2×5 row list showed that the Sugaya classification of rotator cuff re-tear(grade Ⅰto Ⅴ) between the vitamin D deficiency group and the control group was statistically different(=14.228, =0.007). It was discovered that the Sugaya classification after surgery was statistically different between the two groups.
Vitamin D deficiency is not correlated with clinical function scores and re-tear rate, however it is associated with the early postoperative pain (1 and 3 months) and the quality of rotator cuff healing (Sugaya classification) after surgery.
探讨血清维生素D水平与肩袖撕裂修复术后临床疗效之间的相关性。
回顾性分析2018年3月至2020年3月期间符合纳入标准且随访12个月的122例患者，其中男性50例，女性72例，平均年龄（62.10±8.39）岁（范围34至82岁）。所有患者分为缺乏组（维生素D<20μg/L）和对照组（维生素D≥20μg/L），缺乏组62例，维生素D水平为（14.80±3.18）μg/L；对照组60例，维生素D水平为（25.17±5.64）μg/L。比较两组患者的年龄、性别、体重指数（BMI）、撕裂大小、回缩程度、脂肪浸润程度、损伤因素、术后疼痛视觉模拟评分（VAS）、术后肩关节功能评分及再撕裂率。将所有患者年龄分为<60岁和≥60岁两类；BMI分为<24kg/m²和≥24kg/m²；撕裂大小分为≤3cm和>3cm；回缩程度分为≤2cm和>2cm；脂肪浸润分为≤2级和>2级；病程分为≤3个月和>3个月。分析并计算Sugaya再撕裂类型与上述变量之间的相关性。
122例随访患者均未发生关节感染、锚钉拔出及翻修手术等严重并发症。两组患者在年龄、性别、损伤因素、BMI、撕裂大小、回缩程度、脂肪浸润程度及病程方面比较，差异均无统计学意义（>0.05）。两组患者术后Constant-Murley评分、UCLA评分及ASES评分均显著改善（<0.05）；然而，两组患者术后肩关节功能评分比较，差异无统计学意义（>0.05）。两组患者术后1个月和3个月时VAS评分差异有统计学意义，维生素D缺乏组评分更高，术后6个月和12个月时差异无统计学意义。Logistic回归分析显示，撕裂大小（>3cm）、回缩程度（>2cm）、脂肪浸润程度（>2级）均为术后再撕裂的独立危险因素（<0.05）。两组患者采用2×5行列表比较显示，维生素D缺乏组与对照组肩袖再撕裂的Sugaya分类（Ⅰ至Ⅴ级）差异有统计学意义（=14.228，=0.007）。发现两组术后Sugaya分类差异有统计学意义。
维生素D缺乏与临床功能评分及再撕裂率无关，但与术后早期疼痛（1个月和3个月）及术后肩袖愈合质量（Sugaya分类）有关。
