术后 MRI 信号强度与肩袖上盂唇复合体重建术后的功能结果相关。
Postoperative MRI signal intensity correlates functional outcomes after superior capsular reconstruction.
机构信息
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Orthopedic Surgery, Faculty of Medicine, St. Carolus Hospital, Universitas Trisakti, Jakarta, Indonesia.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1903-1909. doi: 10.1007/s00167-022-07111-2. Epub 2022 Aug 18.
PURPOSE
Superior capsular reconstruction (SCR) using fascia lata autograft has been performed for irreparable rotator cuff tear recently. The signal-to-noise quotient (SNQ) of the graft on magnetic resonance imaging (MRI) may reflect the degree of graft maturity and healing. However, how SNQ changes with graft remodelling and time and whether this change correlates with postoperative clinical outcomes after SCR remain unknown. This study aimed to explore the correlation between SNQ of the fascia lata autograft and clinical functional outcomes after SCR.
METHODS
Patients with irreparable posterosuperior rotator cuff tear undergoing SCR using fascia lata autograft between 2013 and 2017 were retrospectively analysed. For clinical outcomes, the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) for pain and range of motion (ROM; forward flexion and external rotation) were evaluated at postoperative 6 and 12 months. Signal intensity of the humeral, mid-substance, and glenoid sites and background were measured to calculate the SNQ values on follow-up MRI at 3 and 12 months. The correlations between clinical outcomes and SNQ at different time points were then analysed.
RESULTS
A total of 15 patients were enrolled in the study. The mean postoperative VAS score significantly increased at postoperative 6 months and significantly decreased at postoperative 12 months. Except for forward flexion, all other functional outcomes were improved at postoperative 6 months. Analysis of MRI showed SNQ at the humeral (SNQh), mid-substance, and glenoid sites decreased from postoperative 3 to 12 months with a statistical significance detected in SNQh (P < 0.01). Correlation analyses showed that the SNQh values negatively correlated with VAS, ASES, Constant-Murley score, SANE, ROM (forward flexion), and ROM (external rotation) (all P < 0.05).
CONCLUSION
SNQ of the fascia lata autograft decreased with time in patients receiving SCR. SNQ at the humeral site was negatively correlated with clinical outcomes.
LEVEL OF EVIDENCE
III.
目的
最近，使用阔筋膜移植物进行 Superior capsular reconstruction（SCR）已用于治疗不可修复的肩袖撕裂。磁共振成像（MRI）上移植物的信噪比（SNQ）可能反映移植物成熟和愈合的程度。然而，SNQ 如何随移植物重塑和时间而变化，以及这种变化是否与 SCR 后的术后临床结果相关，尚不清楚。本研究旨在探讨阔筋膜移植物的 SNQ 与 SCR 后临床功能结果之间的相关性。
方法
回顾性分析 2013 年至 2017 年间接受阔筋膜移植物 SCR 的不可修复的后上肩袖撕裂患者。对于临床结果，在术后 6 个月和 12 个月时，采用美国肩肘外科医师（ASES）评分、Constant-Murley 评分、单项评估数值评估（SANE）和疼痛的视觉模拟量表（VAS）以及活动范围（前屈和外展）进行评估。在术后 3 个月和 12 个月时，对 MRI 随访中测量的肱骨、中部和关节盂部位以及背景的信号强度进行测量，以计算 SNQ 值。然后分析临床结果与不同时间点 SNQ 的相关性。
结果
共有 15 名患者入组本研究。术后 6 个月时，VAS 评分显著升高，术后 12 个月时显著降低。除前屈外，所有其他功能结果在术后 6 个月时均得到改善。MRI 分析显示，肱骨（SNQh）、中部和关节盂部位的 SNQ 从术后 3 个月到 12 个月逐渐降低，SNQh 具有统计学意义（P<0.01）。相关分析表明，SNQh 值与 VAS、ASES、Constant-Murley 评分、SANE、前屈活动范围（ROM）和外展活动范围（ROM）呈负相关（均 P<0.05）。
结论
接受 SCR 的患者的阔筋膜移植物 SNQ 随时间而降低。肱骨部位的 SNQ 与临床结果呈负相关。
证据水平
III 级。
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