■先前的研究强调了预后因素对关节镜肩袖修复(ARCR)成功的影响,但缺乏对肩胛骨下(SSC)肌腱修复愈合的具体关注。
■确定ARCR后SSC愈合的预后因素,并通过纳入这些因素来发展肩胛骨下愈合指数(SSC-HI)。
■病例对照研究;证据水平,3.
■这是一项回顾性研究,使用从2011年至2021年在单一机构接受ARCR且至少2年随访的孤立或合并SSC泪液患者收集的前瞻性维持数据。使用美国肩肘外科医生(ASES)评分评估功能结果,主观肩值(SSV),和视觉模拟量表(VAS)疼痛量表。在最后的随访中通过超声评估SSC肌腱愈合。采用多因素logistic回归分析确定影响SSC愈合的因素,基于这些因素,SSC-HI,范围从0到15分,是使用比值比(OR)开发的。
■在1018名ARCR患者中,931符合纳入标准;279自愿返回进行术后SSC超声评估。总体愈合失败率为10.8%(30/279)。愈合失败的危险因素包括女性(P=0.008;OR,3.119),体重指数(BMI)≥30(P=0.053;OR,2.323),冈上脂肪浸润≥3(P=.033;OR,3.211),较低的SSC脂肪浸润≥2(P=.037;OR,3.608),和Lafosse分类≥3(P=0.007;OR,3.224).15分评分系统包括以下内容:女性3分,BMI≥302分,冈上脂肪浸润≥3分,SSC脂肪浸润≥2分4分,Lafosse分级≥3分3分。≤4分的患者愈合失败率为4%,而≥9分的患者愈合失败率为55%。SSC愈合的患者报告ASES明显升高(SSC愈合:ΔASES,44.7;未愈合的SSC:ΔASES,29;P<.01)和SSV(愈合的SSC:ΔSSV,52.9;未愈合的SSC:ΔSSV,27.5;P<.01)和较低的VAS(已修复的SSC:ΔVAS,-4.2;未愈合的SSC:ΔVAS,-3;P<0.01)与未愈合的SSC相比得分。
■SSC-HI评分系统整合了临床和放射学因素,以预测手术修复后的SSC愈合。发现成功的SSC愈合与增强的功能结果有关,强调SSC愈合预测在这些眼泪管理中的临床相关性。
UNASSIGNED: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking.
UNASSIGNED: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors.
UNASSIGNED: Case-control study; Level of evidence, 3.
UNASSIGNED: This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs).
UNASSIGNED: Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex (P = .008; OR, 3.119), body mass index (BMI) ≥30 (P = .053; OR, 2.323), supraspinatus fatty infiltration ≥3 (P = .033; OR, 3.211), lower SSC fatty infiltration ≥2 (P = .037; OR, 3.608), and Lafosse classification ≥3 (P = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI ≥30, 3 points for supraspinatus fatty infiltration ≥3, 4 points for lower SSC fatty infiltration ≥2, and 3 points for Lafosse classification ≥3. Patients with ≤4 points had a 4% healing failure rate, while those with ≥9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: ΔASES, 44.7; unhealed SSC: ΔASES, 29; P < .01) and SSV (healed SSC: ΔSSV, 52.9; unhealed SSC: ΔSSV, 27.5; P < .01) and lower VAS (healed SSC: ΔVAS, -4.2; unhealed SSC: ΔVAS, -3; P < .01) scores compared with those with an unhealed SSC.
UNASSIGNED: The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.