대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제85권1호
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  • Pages.171-183
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  • 2024
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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수술이 필요한 견갑하건 파열을 예측하기 위한 수술 전 어깨 MRI 소견

Preoperative Shoulder MRI Findings to Predict Subscapularis Tendon Tear Requiring Surgical Repair

  • 정지훈 (한양대학교 의과대학 한양대학교 구리병원 영상의학과) ;
  • 조영훈 (한양대학교 의과대학 한양대학교 구리병원 정형외과) ;
  • 김여주 (한양대학교 의과대학 한양대학교 서울병원 영상의학과) ;
  • 이승훈 (한양대학교 의과대학 한양대학교 서울병원 영상의학과) ;
  • 류정아 (한양대학교 의과대학 한양대학교 구리병원 영상의학과)
  • Ji-hoon Jung (Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Young-Hoon Jo (Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Yeo Ju Kim (Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine) ;
  • Seunghun Lee (Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine) ;
  • JeongAh Ryu (Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine)
  • 투고 : 2023.05.02
  • 심사 : 2023.08.26
  • 발행 : 2024.01.01
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초록

목적 본 연구의 목적은 수술 전 MRI의 다양한 간접 소견 중 어떤 소견이 외과적 치료가 필요한 견갑하건 파열을 예측하는 데 가장 주요한 것인지 조사하는 것이다. 대상과 방법 총 86명의 환자를 대상으로 수술 전 MRI 영상을 후향적으로 분석하였다. 견갑하건 파열의 직접평가, 이두박근 장두의 병리, 상완골두의 후방위, 상완골 회전, 견갑하근의 지방변성과 위축을 평가하였다. En-face 보기에서 부리돌기의 끝과 관절오목의 기저를 연결한 base-to-tip line (이하 BTL)을 이용한 육안 등급 및 두께 측정을 통해서 위축을 평가하였다. 결과 관절경 시술에서 31명(36%)의 환자가 Lafosse type III 또는 IV의 견갑하건 파열을 보여, 재건수술을 받았다. 이두박근 장두의 병리(p = 0.002), 상완골두의 후방위(p = 0.012), 견갑하근의 지방 변성(p < 0.001), BTL 등급(p = 0.003)은 견갑하건 파열과 유의한 상관관계가 있었다. 다변량 분석에서 상완골두의 후방위(p = 0.011, odds ratio [이하 OR] = 5.14)와 견갑하근의 지방변성(p = 0.046, OR = 2.81)은 견갑하건 파열의 독립적인 예측인자였다. 결론 상완골두의 후방위와 지방변성은 견갑하건 파열 진단에 도움이 될 수 있다. 이러한 결과를 판독하는 것은 최적의 수술 전략을 계획하는 데 기여할 수 있다.

Purpose This study aimed to investigate which indirect parameters on preoperative MRI were the principal predictors of subscapularis tendon tears (STTs) requiring surgical repair. Materials and Methods Preoperative MRI scans of 86 patients were retrospectively reviewed for visual assessment of the STT, pathology of the long head of the biceps tendon (LHBT), posterior decentering (PD) of the humeral head, humeral rotation, fatty degeneration, and subscapularis muscle atrophy. To evaluate atrophy, visual grading using the anatomical line connecting the coracoid tip to the glenoid base, designated as the base-to-tip line (BTL), and thickness measurements were performed in the en-face view. Results Arthroscopically, 31 patients (36%) exhibited Lafosse type III or IV STT and underwent surgical repair. LHBT pathology (p = 0.002), PD of the humeral head (p = 0.012), fatty degeneration (p < 0.001), and BTL grade (p = 0.003) significantly correlated with STT. In the multivariate analysis, PD of the humeral head (p = 0.011, odds ratio [OR] = 5.14) and fatty degeneration (p = 0.046, OR = 2.81) were independent predictors of STT. Conclusion PD of the humeral head and fatty degeneration of the subscapularis can help to diagnose clinically significant STT. Interpretation of these findings may contribute to the planning of an optimal surgical strategy.

키워드

과제정보

These results were previously presented in presentation form by Ji-hoon Jung, Preoperative MRI Shoulder Findings to Predict Subscapularis Tendon Tear Requiring Repair, the Radiological Society of North America, Nov 2022 (S4-SSMK02).

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