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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/OL]. 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/OL]. 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）
[1]
刘玉杰，肇刚.关节镜技术在肩关节损伤修复重建中的进展 [J]. 中国骨伤，2020，33(12):1089-1091.
[2]
Hantes ME,Ono Y,Raoulis VA，et al.Arthroscopic single-row versus double-row suture bridge technique for rotator cuff tears in patients younger than 55 years：A prospective comparative study[J].Am J Sports Med,2018,46(1):116-121.
[3]
Sugaya H, Maeda K, Matsuki K, et al. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study[J]. J Bone Joint Surg Am, 2007,89(5):953-960.
[4]
Wu XL, Briggs L, Murrell GA. Intraoperative determinants of rotator cuff repair integrity: an analysis of 500 consecutive repairs[J]. Am J Sports Med, 2012,40(12):2771-2776.
[5]
Zumstein MA, Jost B, Hempel J, et al. The clinical and structural long-term results of open repair of massive tears of the rotator cuff[J]. J Bone Joint Surg Am, 2008, 90(11):2423-2431.
[6]
Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation[J]. Clin Orthop Relat Res, 1990,254:92-96.
[7]
Barth J, Fotiadis E, Barthelemy R, et al. Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(2): 376-385.
[8]
DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair[J]. J Bone Joint Surg Am，1984,66(4):563-567.
[9]
Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears[J]. J Shoulder Elbow Surg, 2003,12(6):550-554.
[10]
Jancuska J, Matthews J, Miller T, et al. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff[J]. Orthop J Sports Med, 2018,6(9):2325967118797891.
[11]
何骁，邓莉莉. 肩关节镜下单排缝合技术治疗不同程度肩袖损伤临床效果分析[J]. 生物医学工程与临床，2021，25(1): 74-80.
[12]
Nozaki T, Tasaki A, Horiuchi S, et al. Predicting Retear after Repair of Full-Thickness Rotator Cuff Tear: Two-Point Dixon MR Imaging Quantification of Fatty Muscle Degeneration-Initial Experience with 1-year Follow-up[J]. Radiology，2016,280(2):500-509.
[13]
Senna LF, Ramos MRF, Bergamaschi RF.Arthroscopic rotator cuff repair：single-row vs. double-row-clinical results after one to four years [J]. Rev Bras Orthop，2018，53(4):448-453.
[14]
Ng SHA,Tan CHJ.Double-row repair of rotator cuff tears:Comparing tendon contact area between techniques[J].World J Orthop,2020,11(1):10-17.
[15]
林涌生，陈宏.肩关节镜下双排与单排缝合治疗肩袖撕裂的疗效比较[J].实用骨科杂志,2021，27(7):583-586.
[16]
张辉，庄万强，骆勇刚,等.关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的对照研究[J/CD].中华老年骨科与康复电子杂志,2019,5(6):337-341.
[17]
黄彪，彭小英，王新亮,等.肩关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的效果[J].齐齐哈尔医学院学报, 2019, 40(8):946-947.
[18]
王良勇，阿布提拉·阿不都热依木，杜红军，等.肩关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的临床效果观察[J]. 中国实用医药,2020，15(7): 91-93.
[19]
Hashiguchi H,Iwashita S,Sonoki K,et al.Clinical outcomes and structural integrity of arthroscopic double-row versus suture bridge repair for rotator cuff tears[J]. J Orthop, 2018,15(2):396-400.
[20]
郑鸿，赵甲军，谭宏昌，等.关节镜下缝线桥与传统双排技术修复全层肩袖撕裂的比较 [J].中华创伤骨科杂志,2017,19(9): 806-809.
[21]
刘来有，吕智. 单排和双排肩袖缝合桥力学研究[J].中国骨伤,2021,34(6):544-549.
[22]
Xu B,Chen L,Zou J,et al.The clinical effect of arthroscopic rotator cuff repair techniques：A network meta-analysis and systematic review[J]. Sci Rep, 2019,9(1):4143.
[23]
裴杰，王青.肩袖撕裂双排缝合技术与缝线桥技术的疗效对比分析[J].中国运动医学杂志,2017,36(1):9-13.
[24]
黄宁庆，刘大圣，张斌,等.肩关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的效果[J].中国老年学杂志, 2018, 38(1): 163-165.
[25]
吕朝辉，王飞，田忠固，等. 肩关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的临床效果比较[J]. 中国实用医药，2020，15(10): 88-90.
[26]
邓明月，向明，陈杭.关节镜下改良缝合桥技术对冈上肌腱损伤患者肩关节活动度、疼痛评分及生活质量的影响 [J]. 解放军医药杂志,2019,31(11): 65-68.
[27]
吴云鹏，田伟，吴剑波，等. 糖尿病对肩袖损伤、修复及并发症影响的文献综述[J]. 骨科，2021，12(1): 92-96.
[28]
Cancienne JM, Brockmeier SF, Carson EW, et al. Risk factors for infection after shoulder arthroscopy in a large medicare population[J]. Am J Sports Med, 2018,46(4): 809-814.
[29]
Borton Z, Shivji F, Simeen S, et al. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair[J]. Shoulder Elbow, 2020, 12(2):109-113.
[30]
杨建水.肩袖修复术后再撕裂相关因素的研究[J].医学信息,2020,33(1):46-50.
[31]
Nichols AEC, Oh I, Loiselle AE. Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing[J]. J Orthop Res,2020,38(1):13-22.
[32]
Gerber C, Vinh TS, Hertel R, et al. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report[J]. Clin Orthop Relat Res,1988,232:51-61.
[33]
Ek ET, Neukom L, Catanzaro S, et al. Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years[J]. J Shoulder Elbow Surg,2013,22(9):1199-1208.
[34]
Collin P, Matsumura N, Lädermann A,et al. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion[J]. J Shoulder Elbow Surg，2014 ,223(8):1195-1202.
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