Kajiyama Shiro, Chiba Ko, Aoki Tatsunari, Sada Kiyoshi, Sato Shuntaro, Osaki Makoto
Department of Sports Medicine Center, Nagasaki University Hospital, Nagasaki, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Front Surg. 2024 Aug 22;11:1416921. doi: 10.3389/fsurg.2024.1416921. eCollection 2024.
Fatty infiltration (FI) of rotator cuff muscles in patients with rotator cuff tears is an important imaging factor for determining surgical indications. However, the associations between FI grade and the size or location of adjacent rotator cuff tears are not well-known. This study aimed to primarily determine whether tear size and location, especially for the SSc tendon, are associated with FI of adjacent rotator cuff muscles. The secondary aim was to clarify which patient factors are associated with rotator cuff muscle FI in rotator cuff tear cases.
This study examined 373 shoulders of 348 patients (264 males and 109 females; mean age of 62.8 years) who underwent arthroscopic rotator cuff surgery. The FI grades of the supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSc) muscles were assessed using preoperative magnetic resonance imaging (MRI) using the Goutallier classification modified by Fuchs. According to the preoperative MRI and intraoperative findings, the tear size of the posterior-superior rotator cuff (SSP-ISP) was classified using a modified six-grade scale of the Cofield classification, and that of the SSc tear was classified using a six-grade scale according to the Lafosse classification. Age at surgery, sex, body mass index (BMI), presence of diabetes mellitus (DM) or hyperlipidemia (HL), trauma history, and duration of symptoms were investigated.
The FI grades of the SSP, ISP, and SSc were significantly associated with the size of the tears in those muscles (all < 0.01). Furthermore, the FI grades of the SSP and the ISP were significantly associated with SSc tear size (< 0.01), and the FI grade of the SSc was significantly associated with SSP-ISP tear size (< 0.01). Patient age at surgery was significantly associated with FI grade (< 0.01), with significant progression of the FI grade with advancing age. However, there were no significant associations between the FI grade and sex, BMI, presence of DM or HL, trauma history, and duration of symptoms.
The FI grade of each of the rotator cuff muscles is affected by not only the tear severity of the muscle concerned but also by the severity of any tear in the adjacent rotator cuff.
肩袖撕裂患者肩袖肌肉的脂肪浸润（FI）是确定手术指征的重要影像学因素。然而，FI分级与相邻肩袖撕裂的大小或位置之间的关联尚不清楚。本研究旨在主要确定撕裂大小和位置，尤其是肩胛下肌腱（SSc）的撕裂大小和位置，是否与相邻肩袖肌肉的FI有关。次要目的是阐明在肩袖撕裂病例中哪些患者因素与肩袖肌肉FI有关。
本研究检查了348例患者（264例男性和109例女性；平均年龄62.8岁）的373个肩部，这些患者均接受了关节镜下肩袖手术。使用经Fuchs修改的Goutallier分类法，通过术前磁共振成像（MRI）评估冈上肌（SSP）、冈下肌（ISP）和肩胛下肌（SSc）的FI分级。根据术前MRI和术中发现，采用改良的Cofield分类六级量表对肩袖后上部分（SSP-ISP）的撕裂大小进行分类，根据Lafosse分类法采用六级量表对SSc撕裂的大小进行分类。调查手术年龄、性别、体重指数（BMI）、糖尿病（DM）或高脂血症（HL）的存在情况、创伤史和症状持续时间。
SSP、ISP和SSc的FI分级与这些肌肉的撕裂大小显著相关（均<0.01）。此外，SSP和ISP的FI分级与SSc撕裂大小显著相关（<0.01），SSc的FI分级与SSP-ISP撕裂大小显著相关（<0.01）。患者手术年龄与FI分级显著相关（<0.01），FI分级随年龄增长显著进展。然而，FI分级与性别、BMI、DM或HL的存在情况、创伤史和症状持续时间之间无显著关联关系。
每个肩袖肌肉的FI分级不仅受相关肌肉撕裂严重程度的影响，还受相邻肩袖撕裂严重程度的影响。
