관절경적 회전근개 봉합술 후 재파열 시 만족도에 영향을 주는 요인-CT 관절조영술 기반 연구-

Abstract

목적 : 회전근개 봉합술 후 재파열은 흔히 볼 수 있으나 임상적 연관성에 대해서는 이견이 있다. 저자는 CT 관절조영술을 통해 술 후 복원 정도를 평가하였고 재파열로 분류된 환자의 만족도에 영향을 끼치는 요인을 알아보았다.

연구대상 및 방법 : 2011년 4월부터 2014년 2월까지 관절경하 회전근개 봉합술 후 재파열로 진단된 50명을 대상으로 하였다. 설문을 통한 환자의 주관적 선택에 의해 만족군과 불만족군으로 구분하였다. CT 관절조영술로 재파열의 분류 및 크기를 평가하였고, 성별, 나이, 직업, 산재여부, 우세 수, 이환 기간, 임상 점수를 조사하였다.

결과 : 총 50명의 환자 중 39명이 만족군, 11명은 불만족군으로 구분되었다. 직업, 우세수 및 이환 기간, 외상 여부, 산재 여부는 만족도와 유의한 관계가 없었다. 재파열의 분류는 두 군에서 차이가 없었으나(p=0.877), 평균 재파열 전후 직경은 만족군에서 5.83mm, 불만족군에서 13mm로 유의한 차이를 보였고(p<0.01) 평균 재파열 면적 또한 각각 10.48mm2과 20.45mm2로 유의한 차이가 있었다(p<0.01). 술 후 평균 VAS 통증 점수는 만족군이 1.7점, 불만족군이 3.9점으로 통계적으로 유의한 차이를 보였다(p<0.01). 두 군의 술 후 평균 ASES 점수는 각각 84.9점과 64.5점으로 역시 유의한 차이를 보였다(p<0.01). 이 항목들을 대상으로 다변량 로지스틱 회귀분석을 시행하였으며, 그 결과 재파열 크기(p=0.049)와 술 후 ASES 점수(p=0.034)가 유의 한 불만족군의 위험인자로 분석되었다.

결론 : CT 관절조영술로 회전근개 봉합술 후 복원 정도를 평가하였을 때 재파열의 크기는 불만족군의 유의미한 위험인자로 분석되었고, 술 후 ASES 점수도 만족도와 상관관계가 있는 것으로 나타났다. 그러나 술 후 부착 부위의 상태에 따른 회전근개의 형태학적 분류는 만족도와 연관성이 없었다.|Propose: The aim of this study is to determine whether the size of retear and the types of repaired rotator cuff evaluated by CT arthrography influence on the patient satisfaction. We also analyzed non-anatomical factors which could affect the patient satisfaction.

Patients and Methods: Fifty patients who were diagnosed as rotator cuff retear after undergoing arthroscopic rotator cuff repair between 2011 and 2014 were included in this study. All the patients were classified as satisfaction or unsatisfaction group dichotomically on the basis of the patients' self-classifications. CT arthrography was used to evaluate the existence of rotator cuff retear, the attachment status of foot print and retear size. Patient’s demographic factors including sex, age, occupation, dominant upper extremity, duration of pain, the presence of diabetes mellitus, trauma history, a history of ipsilateral shoulder surgery, repair technique, worker’s compensation status and functional shoulder score were investigated.

Results: Thirty nine patients were classified as satisfactory group and eleven patients belonged to unsatisfactory group. There were no differences in the age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker’s compensation and duration of follow-up between two groups. However, the postoperative ASES score(p<0.01) and VAS pain level(p<0.01) and the anteroposterior length(p<0.01) and the area of retear site(p<0.01) showed significant differences. As a result of the multivariable analysis, the retear size(p=0.049) and postoperative ASES score(p=0.034) were confirmed as significant risk factors to distinguish between satisfactory and unsatisfactory group.

Conclusion: The retear size estimated by CT arthrography and postoperative ASES score were confirmed as significant risk factors for unsatisfaction. However, the types of repaired rotator cuff judged by the attachment status of footprint did not correlated with the patient satisfaction.; Propose: The aim of this study is to determine whether the size of retear and the types of repaired rotator cuff evaluated by CT arthrography influence on the patient satisfaction. We also analyzed non-anatomical factors which could affect the patient satisfaction.

Patients and Methods: Fifty patients who were diagnosed as rotator cuff retear after undergoing arthroscopic rotator cuff repair between 2011 and 2014 were included in this study. All the patients were classified as satisfaction or unsatisfaction group dichotomically on the basis of the patients' self-classifications. CT arthrography was used to evaluate the existence of rotator cuff retear, the attachment status of foot print and retear size. Patient’s demographic factors including sex, age, occupation, dominant upper extremity, duration of pain, the presence of diabetes mellitus, trauma history, a history of ipsilateral shoulder surgery, repair technique, worker’s compensation status and functional shoulder score were investigated.

Results: Thirty nine patients were classified as satisfactory group and eleven patients belonged to unsatisfactory group. There were no differences in the age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker’s compensation and duration of follow-up between two groups. However, the postoperative ASES score(p<0.01) and VAS pain level(p<0.01) and the anteroposterior length(p<0.01) and the area of retear site(p<0.01) showed significant differences. As a result of the multivariable analysis, the retear size(p=0.049) and postoperative ASES score(p=0.034) were confirmed as significant risk factors to distinguish between satisfactory and unsatisfactory group.

Conclusion: The retear size estimated by CT arthrography and postoperative ASES score were confirmed as significant risk factors for unsatisfaction. However, the types of repaired rotator cuff judged by the attachment status of footprint did not correlated with the patient satisfaction.