检索历史 清除

目的:探讨使用后上四联征（posterosuperior tetralogy，PS-Tetra）评分预测后上型巨大肩袖撕裂修复术预后的可行性。方法:回顾性纳入2016年2月至2020年6月于北京积水潭医院运动医学科接受关节镜下修复巨大后上型肩袖撕裂的患者95例，男48例、女47例，年龄（58.52±8.33）岁（范围27~76岁）；83例完全修复、12例部分修复。使用美国肩肘外科协会（American Shoulder & Elbow Surgeons，ASES）评分与肩关节活动度评估肩关节功能。行MR检查评估术前肩袖脂肪浸润、萎缩、改良Patte分级、PS-Tetra评分与术后肌腱完整性，并比较不同PS-Tetra评分组（0~2分、3~4分）的肩关节功能差异。采用二分类logistic回归分析筛选后上型巨大肩袖撕裂不可修复及术后再撕裂的危险因素。结果:83例完全修复的患者中17例（20%）出现再撕裂。PS-Tetra评分0~2分组术后ASES评分增高[术后（58.52±8.33）分和术前（47.30±17.40）分， t=-19.642， P<0.001]、前屈上举增加（术后157.60°±3.85°和术前116.88°±50.89°， t=-7.272， P<0.001）、外旋增加（术后45.26°±14.69°和术前37.34°±18.65°， t=-4.043， P<0.001）及内旋增加[术后L 1（T 7-臀部）和术前L 2（T 7-臀部）， Z=-2.737， P=0.006]，差异均有统计学意义；PS-Tetra评分3~4分组仅术后ASES评分较术前改善[术后（69.17±15.91）分和术前（46.85±20.73）分， t=-11.167， P=0.001]，肩关节活动度的差异无统计学意义。改良Patte分级Ⅲ级[ OR=26.827，95% CI（2.089，344.500）， P=0.012]是不可修复的危险因素。主力侧[ OR=9.407, 95% CI（1.044，84.784）， P=0.046]与PS-Tetra评分3~4分[ OR=5.037，95% CI（1.028，26.623）， P=0.046]是再撕裂的危险因素。 结论:对后上型巨大肩袖撕裂修复而言，术前PS-Tetra评分≥3分是术后肩关节功能恢复不佳与术后再撕裂的危险因素。

Objective:To assess the feasibility of using the posterosuperior tetralogy (PS-Tetra) score for predicting the prognosis of repair of posterosuperior massive rotator cuff tears.Methods:Data were retrospectively reviewed for patients who underwent repair of posterosuperior massive rotator cuff tears from February 2016 to June 2020. A total of 95 (male 48, female 47) shoulders with an average age of 58.52±8.33 years (range, 27-76 years) were included. The American Shoulder and Elbow Surgeons (ASES) scores and shoulder range of motions (ROM) were used to evaluate shoulder function. MRI was used to assess preoperative fatty infiltration (FI), atrophy, modified Patte's classification, PS-Tetra score and postoperative tendon integrity. The shoulder function was compared between groups of different PS-Tetra scores. The binary logistic regression was used to determine the risk factors of irreparability and retear.Results:83 cases of repair of posterosuperior massive rotator cuff tears were finally included. Complete repairs were performed in 83 cases, and partial repairs were performed in 12 cases. Retear was observed in 17 (20%) cases. The ASES scores (postoperative 58.52±8.33 vs. preoperative 47.30±17.40, t=-19.642, P<0.001), ROM of forward flexion (postoperative 157.60°±13.85° vs. preoperative 116.88°±50.89°, t=-7.272, P<0.001), external rotation (postoperative 45.26°±14.69° vs. preoperative 37.34°±18.65°, t=-4.043, P<0.001) and internal rotation [postoperative L 1 (T 7-buttock) vs. preoperative L 2 (T 7-buttock), Z=-2.737, P=0.006] were significantly improved postoperatively in the group with PS-Tetra score between 0 and 2. In the group with PS-Tetra score of 3 and 4, the ASES scores (postoperative 69.17±15.91 vs. preoperative 46.85±20.73, t=-11.167, P=0.001) were significantly improved postoperatively, while the ROMs were not. Modified Patte stageⅢ[ OR=26.827, 95% CI (2.089, 344.500), P=0.012] was the risk factor of irreparability. Dominant side involvement [ OR=9.407, 95% CI (1.044, 84.784), P=0.046) and PS-Tetra score of 3 and 4 [ OR=5.037, 95% CI (1.028, 26.623), P=0.046] were risk factors of retear. Conclusions:For repair of posterosuperior massive rotator cuff tears, preoperative PS-Tetra score of 3 and 4 was the risk factors of poor postoperative shoulder functions and retear.