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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 7 -13. doi: 10.3877/cma.j.issn.2095-5790.2022.01.003

论著

肩袖损伤关节镜下缝合修复术后再撕裂的风险因素分析
陈宇琦1, 张磊2, 石慧生3, 韩庆欣3, 孙晋2, 马佳2, 刘晓华2, 姜博2, 李妍2, 范丁元3, 张晟2,†()   
  1. 1. 100029　北京中医药大学；100102　北京，中国中医科学院望京医院骨关节四科
    2. 100102　北京，中国中医科学院望京医院骨关节四科
    3. 100029　北京中医药大学
  • 收稿日期:2021-05-20 出版日期:2022-02-05
  • 通信作者: 张晟
  • 基金资助:
    中国中医科学院望京医院院级科研课题(WJYY2020-14)

Risk factors analysis of retear after arthroscopic suture repair of rotator cuff injury

Yuqi Chen1, Lei Zhang2, Huisheng Shi3, Qingxin Han3, Jin Sun2, Jia Ma2, Xiaohua Liu2, Bo Jiang2, Yan Li2, Dingyuan Fan3, Sheng Zhang2,†()   

  1. 1. Beijing University of Chinese Medicine, Beijing 100029, China; Four Departments of Osteoarthrosis, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
    2. Four Departments of Osteoarthrosis, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
    3. Beijing University of Chinese Medicine, Beijing 100029, China
  • Received:2021-05-20 Published:2022-02-05
  • Corresponding author: Sheng Zhang
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引用本文：

陈宇琦, 张磊, 石慧生, 韩庆欣, 孙晋, 马佳, 刘晓华, 姜博, 李妍, 范丁元, 张晟. 肩袖损伤关节镜下缝合修复术后再撕裂的风险因素分析[J]. 中华肩肘外科电子杂志, 2022, 10(01): 7-13.

Yuqi Chen, Lei Zhang, Huisheng Shi, Qingxin Han, Jin Sun, Jia Ma, Xiaohua Liu, Bo Jiang, Yan Li, Dingyuan Fan, Sheng Zhang. Risk factors analysis of retear after arthroscopic suture repair of rotator cuff injury[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(01): 7-13.

目的

研究肩袖损伤肩关节镜下缝合术后发生再撕裂的风险因素，为术前评估术后再撕裂风险的大小及手术方式提供临床参考。

方法

回顾性分析2015年1月至2019年1月624例在本科因"肩袖全层撕裂"住院并接受肩关节镜下肩袖缝合修复术患者的临床资料。使用二元Logistic回归分析方法研究术后肩袖再撕裂的风险因素。

结果

病程>3个月、术前撕裂范围>3 cm、单排固定方式、脂肪浸润程度较高（Goutallier3级及以上）、糖尿病史及术后外伤均为术后肩袖再撕裂的高风险因素（P<0.05）。患者年龄、性别、是否优势肩、吸烟史、是否从事竞技运动等与肩袖术后再撕裂无明显相关（P>0.05）。

结论

病程长、术前撕裂范围大、单排固定方式、肌肉脂肪浸润程度较高、糖尿病史及术后外伤均可能造成术后肩袖发生再撕裂。

关键词: 肩袖, 再撕裂, 关节镜, 术后, 风险因素
Background

Rotator cuff tear refers to the injury of rotating muscles around shoulder joint. The majority of patients were middle-aged and elderly people. The common causes of tear include trauma, exercise, degeneration of rotator cuff tendon and abnormal shape of shoulder acromion. Arthroscopic suture repair is one of the main methods to treat rotator cuff injury at present, but literatures report that there is still 11%-94% retear rate after arthroscopic repair.

Objective

To evaluate the preoperative factors of rotator cuff retear after the arthroscopic repair and to provide proper surgical treatment options.

Methods

From January 2015 to January 2019, 624 consecutive patients with full-thickness rotator tear who underwent arthroscopic repair were retrospectively analyzed. Binary Logistic regression analysis was used to investigate the risk factors for rotator cuff retear after operation.

Results

The course of disease>3 months, preoperative tear size>3 cm, single-row fixation, high grade of fatty infiltration (Goutallier ≥3 grade) , history of diabetes and postoperative trauma were all high risk factors for rotator cuff retear (P<0.05) . Age, gender, dominant arm, smoking history, or competitive sports were not related (P>0.05) .

Conclusion

Long duration of disease, large tear size, high grade of fatty degeneration, single-row fixation, history of diabetes and postoperative trauma are high independent risk factors for rotator cuff retear.

Key words: Rotator cuff, Retear, Arthroscopy, Post-operation, Risk factors
图1 Cofield分型小撕裂（图A）、Cofield分型中等撕裂（图B）、Cofield分型大撕裂（图C）、Cofield分型巨大撕裂（图D）
图2 术后Sugaya B超分级Ⅰ型
图3 术后Sugaya B超分级Ⅱ型
图4 术后Sugaya B超分级Ⅲ型
表1 关节镜术后肩袖再撕裂危险因素及二元Logisitic回归分析结果
因素 愈合 再撕裂 OR值 95% CI P值
（n＝557） （n＝67） 下限 上限
年龄
<65岁 421 43
≥65岁 136 24 0.842 0.102 6.246 0.875
性别
男 229 32
女 328 35 1.373 0.710 3.616 0.585
病程
≤3个月 251 19
>3个月 306 48 3.875 1.025 8.419 0.022
优势肩
否 238 23
是 319 44 1.612 0.667 3.432 0.199
术前撕裂大小
小 91 7
中 294 16 1.101 0.931 7.545 0.072
大 125 26 2.412 1.131 5.733 0.043
巨大 47 18 7.354 1.335 25.427 <0.001
手术方式
双排 412 40
单排 145 27 5.145 1.310 21.279 0.027
术前肌肉质量
0级 67 6
Ⅰ级 202 13 1.199 0.914 1.337 0.347
Ⅱ级 182 16 1.582 0.405 5.149 0.430
Ⅲ级 73 20 7.034 2.981 24.180 0.011
Ⅳ级 33 12 15.239 6.312 34.866 <0.001
术后外伤史
无 546 63
有 11 4 2.033 1.178 3.707 0.017
吸烟史
无 421 49
有 136 18 1.207 0.278 3.059 0.865
糖尿病史
无 433 46
有 124 21 2.498 1.150 5.185 0.003
从事竞技运动
否 459 56
是 98 11 1.103 0.265 4.822 0.918
图5 术后肩袖再撕裂风险森林图
图6 单排带线锚钉固定方式（图A）和双排缝线桥技术（图B）
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