Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

회전근 개 봉합술 후 발생한 재파열의 양상 - 109예의 자기 공명 영상 검사 분석 -

Patterns of Retear After Repair of the Rotator Cuff - MRI Analysis of 109Cases -

  • 태석기 (동국대학교 일산병원 정형외과) ;
  • 김영성 (동국대학교 경주병원 정형외과) ;
  • 이호민 (동국대학교 경주병원 정형외과) ;
  • 박판건 (동국대학교 일산병원 정형외과)
  • Tae, Suk-Kee (Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital) ;
  • Kim, Young-Sung (Department of Orthopaedic Surgery, Dongguk University Gyeongju Hospital) ;
  • Lee, Ho-Min (Department of Orthopaedic Surgery, Dongguk University Gyeongju Hospital) ;
  • Park, Pan-Kun (Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital)
  • 투고 : 2012.04.27
  • 심사 : 2012.06.05
  • 발행 : 2012.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 관절경적 회전근 개 봉합술 후 시행한 자기 공명 영상 검사 소견을 분석하여 재파열의 빈도와 발생 위치, 재파열이 임상적 결과에 미치는 영향 등을 알아보고자 하였다. 대상 및 방법: 관절경적 회전근 개 봉합술 후 평균 10.6개월에 자기 공명 영상 검사를 시행한 109예 (평균 연령 57세, 남:여=50예:59예)를 대상으로 하였다. 관상면 자기 공명 영상 검사 상 Sugaya IV, V 형을 재파열로 규정하였다. 재파열의 위치는 앵커 삽입부위 내측 1 cm를 기준으로 내측 및 외측으로 구분하였다. 나이, 성별, 파열의 크기 및 복원 방법에 따른 재파열의 빈도와 위치를 알아보았으며, 평균 13.9개월에 추시 후 재파열 유무에 따른 견관절 기능점수의 차이를 조사하였다. 결과: 109예 중 38예 (34.9%)에서 재파열을 보였다. 남성에서 재파열은 25예 (50.0%)가 발생하였으며, 여성에서 재파열은 13예 (22.0%)가 발생하였다. 3 cm미만 크기의 파열에서는 21예 (25.6%)에서 재파열이 발생하였으며, 3 cm를 넘는 크기의 파열에서는 17예 (63.0%)에서 재파열이 발생하였다. 재파열이 내측에서 발생한 경우는 일열봉합에서 71.4%, 이열봉합에서 71.0%이었다. 최종 추시점에서 재파열군과 재파열이 없는 군 모두 견관절 기능점수는 통계학적으로 유의한 호전을 보였으며 양 군간의 호전 정도의 차이는 없었다. 결론: 회전근 개 봉합술 후 추적 자기 공명 영상 검사상 34.9%에서 재파열이 발생하였으며 환자의 나이, 복원방법에 따른 발생률의 차이는 없었으나 남성 및 파열크기가 큰 경우 재파열의 가능성이 높았다. 재파열은 주로 내측에서 발생하는 것을 관찰할 수 있었는데 이는 봉합시 과도한 긴장이 봉합부의 내측에 부하되기 때문인 것으로 보인다.

Purpose: This study was designed to investigate the rate of incidence, location and the clinical value of the rotator cuff retear by analyzing MRI scans, which was taken after an arthroscopic rotator cuff repair. Materials and Methods: This study included a total of 109 patients, who underwent a shoulder MRI scan after an average of 10.6 months later from the arthroscopic rotator cuff repair. We only defined the 'retear' when the Sugaya type IV and V was observed in the sagittal section of the MRI. The location of the retear was divided into the medial and lateral areas by the site, which was 1 cm medial to the anchor insertion. We investigated the incidence rate and the location of the retear, in terms of the age, sex, initial tear size and the suture method. Also, we compared the functional score of the retear group and the non-retear group, after an average of 13.9 months follow-up. Results: There were 38 of the 109 patients that showed the rotator cuff retear. Of these patients, 25 were male patients, and 13 were female patients. Of the 38 patients with the rotator cuff retear, 21 patients were included in the <3 cm retear group, and 17 were included in the ${\geqq}3$ cm retear group. At the end of the follow up period, all 109 patients showed a statistical significant improvement in the shoulder functional score. Conclusion: According to the follow up of the MRI scan, which was taken after the rotator cuff repair, the retear rate reached 34.9 %, and there were no significant differences on the age and the suture method. More rotator cuff retear occurred in male patients, and the initial tear size was positively correlated with the incidence rate of the rotator cuff retear. Also, the retear was more frequently observed at the medial side. That is because when the suture was performed, excessive tension was loaded on the medial side of the suture site.

키워드

참고문헌

  1. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86:219-24. https://doi.org/10.2106/00004623-200402000-00002
  2. Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res. 1994;304:43-53.
  3. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82:505-15. https://doi.org/10.2106/00004623-200004000-00006
  4. Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Masten FA 3rd. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73:982-9. https://doi.org/10.2106/00004623-199173070-00004
  5. Jost B, Pfirrmann CW, Gerber C. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82:304-14. https://doi.org/10.1302/0301-620X.82B2.10931
  6. Klepps S, Bishop J, Lin J, et al. Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs. Am J Sports med. 2004;32:1716-22. https://doi.org/10.1177/0363546504265262
  7. Knudsen HB, Gelineck J, S􀝚jbjerg JO, Olsen BS, Johannsen HV, Sneppen O. Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999;8:242-6. https://doi.org/10.1016/S1058-2746(99)90136-2
  8. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997:275-83.
  9. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal? J Bone Joint Surg Am. 2005;87:1229-40. https://doi.org/10.2106/JBJS.D.02035
  10. Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic fullthickness rotator cuff repair: single-row versus duallow fixation. Arthroscopy. 2005;21:1307-16. https://doi.org/10.1016/j.arthro.2005.08.011
  11. Bellumore Y, Mansat M, Assoun J. Results of the surgical repair of the rotator cuff. Radio-clinical correlation. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:582-94.
  12. Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR imaging of the shoulder after rotator cuff repair. AJR Am J Roentgenol. 1997;168:559-63. https://doi.org/10.2214/ajr.168.2.9016248
  13. Chun JM, Song JS, Sohn DW. Clinical outcome and causative factor in patients of structural failure after rotator cuff repair. J of Korean Shoulder and Elbow Society. 2008;11:29-36. https://doi.org/10.5397/CiSE.2008.11.1.029
  14. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136-44. https://doi.org/10.2106/00004623-198668080-00002
  15. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987:160-4.
  16. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006;15:290-9. https://doi.org/10.1016/j.jse.2005.09.017
  17. Frank JB, Elattrache NS, Dines JA, Blackburs A, Crues H, Tibone JE. Repair site integrity after arthroscopic transosseous equivalent suture-bridge rotator cuff repair. Am J Sports Med. 2008;36:1496-503. https://doi.org/10.1177/0363546507313574
  18. Lo IK, Burkhart SS. Double-row arthroscopic rotator cuff repair: Re-establishing the footprint of the rotator cuff. Arthroscopy. 2003;19:1035-42. https://doi.org/10.1016/j.arthro.2003.09.036
  19. Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. 2005;43:771-807. https://doi.org/10.1016/j.rcl.2005.02.011
  20. Motamedi AR, Urrea LH, Hancock RE, Hawkins RJ, Ho C. Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears. J Shoulder Elbow Surg. 2002;11:6-10. https://doi.org/10.1067/mse.2002.120139
  21. Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis DS, Palladas P, Fezoulidis IV. Ultrasonsgraphy of symptomatic rotator cuff tears compared with MR imaging and surgery. Eur J Radiol. 2008; 68(1):174-9. https://doi.org/10.1016/j.ejrad.2007.11.002
  22. Hodler J, Kursunoglu-Brahme S, Snyder SJ, et al. Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. Radiology. 1992;182:431-6. https://doi.org/10.1148/radiology.182.2.1489363
  23. Iannotti JP, Ciccone J, Buss DD, et al. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am. 2005;87:1305-11. https://doi.org/10.2106/JBJS.D.02100
  24. Magee TH, Gaenslen ES, Seitz R, Hinson GA, Wetzel LH. MR imaging of the shoulder after surgery. AJR Am J Roentgenol. 1997;168:925-8. https://doi.org/10.2214/ajr.168.4.9124141
  25. Gerber C, Schneeberber AG, Perren SM, Nyffeler RW. Experimental rotator cuff repair. J Bone Joint Surg Am. 1999;81:1281-90. https://doi.org/10.2106/00004623-199909000-00009
  26. Montamedi AR, Urrea LH, Hancock RE, Hawkins RJ, Ho C. Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears. J Shoulder Elbow Surg. 2002;11:6-10. https://doi.org/10.1067/mse.2002.120139
  27. Cho CH. Gender-related difference in intravenous patient-controlled analgesia for postoperative pain control in rotator cuff repair. J Korean Orthop Assoc. 2010;45:31-6. https://doi.org/10.4055/jkoa.2010.45.1.31

피인용 문헌

  1. Risk Factors for Retear After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears Using the Suture Bridge Technique: Classification System vol.32, pp.11, 2016, https://doi.org/10.1016/j.arthro.2016.03.012