术前磁共振成像指标对肩袖全层撕裂患者行关节镜下肩袖修补手术后疗效的预测价值分析

Analysis of the predictive value of preoperative MRI index for the outcome of rotator cuff repair in patients with full thickness rotator cuff tear under arthroscopy

摘要:

目的 分析术前磁共振成像（MRI）指标对肩袖全层撕裂（FTRCT）患者行关节镜下肩袖修补手术（ARCR）后疗效的预测价值。方法 选择2020年1月－2023年12月该院收治的451例FTRCT患者，均接受ARCR治疗，回顾性分析患者的临床资料，随访1年，依据上肢功能障碍评定量表（DASH）评分，将患者分为肩关节功能改善组（n = 415）与肩关节功能未改善组（n = 36）。比较两组患者术前MRI指标和临床指标，采用多因素Logistic回归模型，分析FTRCT患者行ARCR后疗效的影响因素，绘制受试者操作特征曲线（ROC curve），分析术前MRI指标单独检测及联合检测，对FTRCT患者行ARCR后疗效的预测价值。结果 451例行ARCR的FTRCT患者，术后随访1年分析其疗效，肩关节功能未改善发生率为7.98%。与肩关节功能改善组比较，肩关节功能未改善组术前肌腱撕裂宽度和肌腱回缩距离更长，肌腱退变程度更高，肩峰肱骨间隙更短（P < 0.05）。相较于肩关节功能改善组，肩关节功能未改善组年龄更大（P < 0.05）。多因素Logistic回归分析结果显示，肩峰肱骨间隙 ≤ 7.15 mm（OR＾ = 2.208，95%CI：1.255～3.883）、肌腱退变程度2级至3级（OR＾ = 1.817，95%CI：1.066～3.096）、肌腱撕裂宽度 > 2.16 cm（OR＾ = 2.246，95%CI：1.242～4.059）和肌腱回缩距离 > 2.10 cm（OR＾ = 2.186，95%CI：1.311～3.646）为FTRCT患者行ARCR后肩关节功能未改善的危险因素（P < 0.05）。将肩关节功能未改善纳入阳性，肩关节功能改善纳入阴性，绘制ROC curve，分析术前MRI指标联合检测对FTRCT患者行ARCR后疗效的预测价值，曲线下面积（AUC）为0.903，敏感度为86.11%，特异度为87.47%。结论 FTRCT患者行ARCR后疗效较好，肌腱撕裂宽度 > 2.16 cm、肌腱回缩距离 > 2.10 cm、肌腱退变程度2级至3级和肩峰肱骨间隙 ≤ 7.15 mm为其疗效不良的危险因素，术前MRI指标联合检测的预测价值较高。

Abstract:

Objective To analyze the predictive value of preoperative magnetic resonance imaging (MRI) indexes in patients with full thickness rotator cuff tear (FTRCT) undergoing arthroscopic rotator cuff repair (ARCR).Methods Clinical data of 451 patients with FTRCT undergoing ARCR from January 2020 to December 2023 were retrospectively included as the study objects. All patients were followed up for 1 year after surgery. Patients were divided into the shoulder joint function improvement group (n = 415) and the shoulder joint function non-improvement group (n = 36) according to scores of disabilities of the arm shoulder and hand (DASH). The preoperative MRI indicators and clinical indicators of the two groups were compared, and the risk factors of the outcome after ARCR in patients with FTRCT were analyzed by multivariate Logistic regression, and the receiver operating characteristic curve (ROC curve) was drawn. The predictive value of preoperative MRI indexes alone and in combination in patients with FTRCT undergoing ARCR was analyzed.Results 451 patients with FTRCT after ARCR were followed up for 1 year. The incidence of shoulder joint function non-improvement was 7.98%. Compared with the shoulder joint function improvement group, the shoulder joint function non-improvement group had longer preoperative tendon tear width and tendon retraction distance, higher degree of tendon degeneration, and shorter acromial humeral space (P < 0.05). Acromial humeral space ≤7.15 mm (OR＾ = 2.208, 95%CI: 1.255 ~ 3.883), tendon degeneration degree 2-3 (OR＾ = 1.817, 95%CI: 1.066 ~ 3.096), tendon tear width > 2.16 cm (OR＾ = 2.246, 95%CI: 1.242 ~ 4.059) and tendon retraction distance > 2.10 cm (OR＾ = 2.186, 95%CI: 1.311 ~ 3.646) were risk factors for non-improvement of the shoulder joint in patients with FTRCT after ARCR (P < 0.05). Positive as shoulder joint function nonimprovement was included and negative as shoulder joint function improvement, ROC was drawn, and the predictive value of preoperative MRI indexes detection alone and combined in patients with FTRCT after ARCR was analyzed. The area under the curve (AUC) was 0.903, the sensitivity was 86.11%, and the specificity was 87.47%.Conclusion Patients with FTRCT who underwent ARCR surgery have better outcomes. Tendon tear width > 2.16 cm, tendon retraction distance > 2.10 cm, tendon degeneration degree of grade 2 to 3, acromial humeral space ≤ 7.15 mm are risk factors for poor outcomes, and the combined detection of preoperative MRI indexes has high predictive value.