【摘要】 目的：探究大型及巨大肩袖撕裂修复的不可修复性与术后再撕裂的危险因素。方法：回顾性分析187例大型及巨大肩袖撕裂修复的临床与影像学资料。测量脂肪浸润（Goutallier分级）、肌腱回缩（改良Patte分级）、冈上肌切线征、小圆肌增生与肩峰肱骨头间距（acromiohumeral distance,AHD）。通过单因素分析与二元Logistic回归分析，确定不可修复性与术后再撕裂的危险因素。通过粗一致性、灵敏度、特异度、阳性预测值和阴性预测值，评估以不同危险因素预测大型及巨大肩袖撕裂不可修复性与术后再撕裂的准确性与收益性。结果：在187例纳入病例中，18例为部分修复；169例为完全修复，其中32例术后再撕裂。二元Logistic回归分析结果显示，改良Patte分级Ⅲ级（P=0.002）与AHD<4 mm(P=0.022)为不可修复性的危险因素，改良Patte分级Ⅲ级（P=0.029）与肌腱修复质量2级（P=0.001）为再撕裂的危险因素。以改良Patte Ⅲ级预测不可修复性与再撕裂，分别具有良好的粗一致性（89.8%与84.0%）、特异度（95.9%与99.3%）与阴性预测值（93.1%与84.0%）。结论：在大型及巨大肩袖撕裂修复中，改良PatteⅢ级和AHD<4 mm是不可修复性的危险因素，改良PatteⅢ级和肌腱修复质量2级是再撕裂的危险因素。改良PatteⅢ级在预测不可修复性及再撕裂风险时，具有较高的粗一致性、特异度和阴性预测值，具有良好的准确性和收益性。更多还原

【Abstract】 Objective To explore the risk factors of irreparability and retear of large to massive rotator cuff repairs. Methods The clinical and imaging data of 187 patients with large to massive rotator cuff repairs were observed retrospectively. Their fatty infiltration(Goutallier classification),tendon retraction(modified Patte classification),tangent sign of supraspinatus,teres minor hypertrophy and acromiohumeral distance(AHD) were measured. Univariate analysis and binary logistic regression analysis were conducted to determine the independent risk factors of irreparability and retear. The accuracy of using the risk factors to predict irreparability and retear was estimated. Results Among the 187 cases,18 partial and 169 complete repairs were performed,with retear occurring in 32 cases. According to the binarylogistic regression analysis,the modified Patte stage Ⅲ（P=0.002） and AHD<4 mm(P=0.022) were risk factors of irreparability, but modified Patte stage Ⅲ（P=0.029） and repair quality grade 2(P=0.001) were risk factors of retear. High crude agreement(89.8% and 84.0%),specificity(95.9% and99.3%) and negative predictive value(93.1% and 84.0%) were observed when using the modified Patte stage Ⅲ to predict irreparability and retear. Conclusion For large to massive rotator cuff repairs,the modified Patte stage Ⅲ and AHD<4 mm are risk factors of irreparability,while the modified Patte stage Ⅲ and repair quality grade 2 are risk factors of retear. Moreover,the modified Patte stage Ⅲis of great accuracy,high crude agreement,specificity and negative predictive value in predicting irreparability and retear.更多还原