■部分厚度肩袖撕裂(PTRCT)通常发展为全厚度肩袖撕裂(FTRCT)。因此,重要的是分析撕裂进展的危险因素,以确定正确的修复时机。
■确定与PTRCT进展相关的危险因素。
■病例对照研究;证据水平,3.
■包括在2012年8月至2019年8月期间在作者机构接受非手术治疗的89例磁共振成像(MRI)扫描诊断为PTRCT的患者。患者特征,肩部僵硬(与对侧肩部相比);工作水平(归类为高[重体力劳动],中等[活动较少的体力劳动],和低[久坐活动]);和放射学因素,包括初始泪液大小,肩峰型(扁平,弯曲的,上钩了,或脚跟形),和初始撕裂受累(作为肩袖肌腱足迹长度的百分比)进行分析,以评估其与撕裂进展的关联,定义为泪液受累增加>20%。
■平均MRI随访期为22.3±17.2个月(中位数,16.1个月;范围,6.4-89.5个月),在12例患者中观察到泪液进展(13.5%)。在这12名患者中,撕裂参与增加了60%的肩袖足迹,而中外侧(ML)和前后(AP)泪液大小增加了1.1和1.8mm,分别。单因素回归分析显示肩关节僵硬度(P=.031),工作水平(P=.001),初始泪液受累(P<.001),ML和AP撕裂尺寸(分别为P<.001和P=.005),和肩峰型(P=0.003)与泪液进展显著相关。多元回归分析显示,初始泪液受累(比值比[OR],1.053;95%CI,1.006-1.102;P=0.026)和高工作水平(OR,15.831;95%CI,1.150-217.856;P=0.039)是泪液进展的独立危险因素。初始泪液受累的临界值为47.5%(灵敏度,81.8%;特异性,85.7%)。
■本研究中14%的PTRCT患者出现泪液进展。为了预测泪液的进展,在初始MRI期间评估泪膜受累情况至关重要.泪液进展的风险随着初始泪液参与>47.5%和繁重的工作水平而增加。
UNASSIGNED: Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair.
UNASSIGNED: To identify the risk factors associated with progression of PTRCT.
UNASSIGNED: Case-control study; Level of evidence, 3.
UNASSIGNED: Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors\' institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement.
UNASSIGNED: The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness (P = .031), work level (P = .001), initial tear involvement (P < .001), ML and AP tear sizes (P < .001 and P = .005, respectively), and acromion type (P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%).
UNASSIGNED: Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.