| 摘要: |
| 目的：探讨肩袖损伤患者肌骨超声影像特点，分析肩袖损伤预后的影响因素，构建肩袖损伤预后的预测模型。方法：回顾性分析2021年2月至2023年6月82例疑似肩袖损伤患者的临床资料。分析肌骨超声的影像特点，分析肌骨超声与关节镜的一致性。采用单因素分析以及多因素logistic回归分析肩袖损伤预后的影响因素并构建预测模型。结果：经关节镜检查确诊为肩袖损伤73例。肌骨超声显示肩袖肌腱连续性中断，断端回缩，肩袖纤维不连续，超声显示无回声或者低回声。肌骨超声诊断肩袖损伤的灵敏度为90.41%，特异度为88.89%，准确率为90.24%，肌骨超声与关节镜的一致性中等（kappa=0.614）。73例肩袖损伤患者预后良好59例，预后不良14例。年龄≥60岁（OR=1.634）、肩袖撕裂程度（OR=2.869）、肩袖肌肉萎缩程度（OR=2.389）是导致肩袖损伤患者预后不良的危险因素（P＜0.05）。肩袖损伤患者预后的预测模型：P=ex/(1+ex)，X=-4.337+0.491×年龄+1.054×肩袖撕裂程度+0.871×肩袖肌肉萎缩程度。预测模型的ROC曲线下面积为0.805（95%CI=0.691-0.919，P＜0.001），灵敏度为71.43%，特异度为77.97%。结论：肌骨超声对肩袖损伤具有较高的诊断价值，能为术前诊断提供参考。年龄、肩袖撕裂程度、肩袖肌肉萎缩程度是导致肩袖损伤患者预后不良的影响因素，本研究构建的预测模型准确度较高，对预测肩袖损伤预后具有一定的指导意义。 |
| 关键词: 肩袖损伤 肌骨超声 关节镜 预后 预测模型 |
| DOI： |
| 投稿时间：2024-05-14修订日期：2024-10-10 |
| 基金项目:浙江省医药卫生科技计划项目、新技术适宜技术培育推广计划 （2019KY738） |
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| Musculoskeletal ultrasonographic features of patients with rotator cuff injury and construction of prediction model for prognosis |
| xieguocheng,liushuhua |
| () |
| Abstract: |
| Objective: To investigate the musculoskeletal ultrasonographic features of patients with rotator cuff injury, analyze the prognostic factors of rotator cuff injury and construct a prediction model for the prognosis. Methods: A retrospective analysis was conducted on the clinical data of 82 patients who were suspected of rotator cuff injury and admitted to the hospital from February 2021 to June 2023. The musculoskeletal ultrasonographic features and the consistency between musculoskeletal ultrasonography and arthroscopy were analyzed. Univariate analysis and multivariate logistic regression analysis were conducted to screen the prognostic factors of rotator cuff injury and a prediction model was constructed. Results: Arthroscopy diagnosed 73 cases of rotator cuff injury. Musculoskeletal ultrasonography showed continuous interruption of rotator cuff tendon, with broken end retracting and discontinuous rotator cuff fibers. Ultrasound showed no echo or hypoecho. The sensitivity, specificity and accuracy of musculoskeletal ultrasonography for diagnosing rotator cuff injury were 90.41%, 88.89% and 90.24%. The consistency between musculoskeletal ultrasonography and arthroscopy was at a middle level (kappa=0.614). Among 73 patients with rotator cuff injury, 59 patients had good prognosis and 14 patients had poor prognosis. Age ≥ 60 years (OR=1.634), degree of rotator cuff tear (OR=2.869) and degree of rotator cuff muscle atrophy (OR=2.389) were risk factors for poor prognosis in patients with rotator cuff injury (P<0.05). The prediction model for the prognosis of patients with rotator cuff injury was P=ex/(1+ex), X=-4.337+0.491×age+1.054×degree of rotator cuff tear+0.871×degree of rotator cuff muscle atrophy. The area under the ROC curve of the prediction model was 0.805 (95% CI=0.691-0.919, P<0.001). Its sensitivity and specificity were 71.43% and 77.97%. Conclusion: Musculoskeletal ultrasonography has relatively high diagnostic value for rotator cuff injury and can provide reference for preoperative diagnosis. Age, degree of rotator cuff tear and degree of rotator cuff muscle atrophy are influencing factors of poor prognosis in patients with rotator cuff injury. The prediction model constructed in this study has high accuracy and has certain significance for predicting the prognosis of rotator cuff injury. |
| Key words: Rotator cuff injury Musculoskeletal ultrasonography Arthroscopy Prognosis Prediction model |
