Kim Eugene, Kopp Benjamin, Kortlever Joost T P, Johnson Anthony, Ring David
Department of Surgery and Perioperative Care, Dell Medical School - the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA.
J Orthop. 2023 Jan 20;36:125-129. doi: 10.1016/j.jor.2023.01.007. eCollection 2023 Feb.
INTRODUCTION: Sizable rotator cuff defects with limited muscle atrophy and fat replacement may represent acute traumatic ruptures that are less likely to recur after surgery to close the defect, while closure of defects with poor quality muscle are associated with defect recurrence. These distinct lesions are both referred to as tears. We analyzed the relationship between rotator cuff defect size and muscle quality to determine the relative proportion of sizable defects associated with good muscle and factors associated with muscle deterioration. MATERIAL AND METHODS: A cohort of 230 consecutive shoulder MRIs in patients with full-thickness rotator cuff tendon defects, limited acromioclavicular arthrosis (to avoid hindrance of defect measurement), and a duration of symptoms in the radiology report from a large urban center in the United States was evaluated for the measured distance between the supraspinatus tendon edge and the greater tuberosity medial to lateral (coronal plane defect size), anterior to posterior (sagittal plane defect width), and fatty infiltration (Goutallier classification), and atrophy (Warner classification) of the supraspinatus. We sought factors independently associated with fatty infiltration and muscle atrophy in multivariable logistic regression analyses. RESULTS: Forty-nine of 109 shoulders (45%) with a coronal plane defect >20 mm had reasonable muscle quality as defined by Goutallier grade less than 2 and Warner grade less than 2. Both greater fatty infiltration of the supraspinatus muscle and greater supraspinatus muscle atrophy were associated with older age and greater coronal plane defect size. CONCLUSION: The observation that supraspinatus muscle health deteriorates with age and defect size, but nearly half of the largest defects had good muscle, suggests an important distinction between relatively recent traumatic ruptures and old untreated rupture or gradual attrition that may be obfuscated by referring to all lesions as tears. LEVEL OF EVIDENCE: Level III; Retrospective diagnostic cohort.
引言：伴有有限肌肉萎缩和脂肪替代的大型肩袖缺损可能代表急性创伤性撕裂，此类撕裂在手术闭合缺损后复发可能性较小，而肌肉质量较差的缺损闭合与缺损复发相关。这些不同的病变均被称为撕裂。我们分析了肩袖缺损大小与肌肉质量之间的关系，以确定与良好肌肉相关的大型缺损的相对比例以及与肌肉退变相关的因素。 材料与方法：对来自美国一个大型城市中心的230例连续肩部磁共振成像（MRI）进行队列研究，这些患者患有全层肩袖肌腱缺损、有限的肩锁关节病（以避免妨碍缺损测量），且放射学报告中有症状持续时间。评估了冈上肌腱边缘与大结节之间从内侧到外侧（冠状面缺损大小）、从前到后（矢状面缺损宽度）的测量距离，以及冈上肌的脂肪浸润（Goutallier分类）和萎缩（Warner分类）。我们在多变量逻辑回归分析中寻找与脂肪浸润和肌肉萎缩独立相关的因素。 结果：在109例冠状面缺损>20 mm的肩部中，有49例（45%）的肌肉质量合理，定义为Goutallier分级小于2级且Warner分级小于2级。冈上肌脂肪浸润增加和冈上肌萎缩增加均与年龄较大和冠状面缺损较大有关。 结论：观察到冈上肌健康状况随年龄和缺损大小而恶化，但近一半最大缺损的肌肉状况良好，这表明相对近期的创伤性撕裂与陈旧性未治疗撕裂或逐渐磨损之间存在重要区别，而将所有病变都称为撕裂可能会混淆这种区别。 证据水平：III级；回顾性诊断队列。
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