Omuz MR görüntülemelerinde rotator manşet yırtığı saptanan hastalarda anatomik ölçümlerin prediktif açıdan incelenmesi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Rotator manşet yırtklarının (RMY) etyolojisi multifaktoriyeldir. Bu faktörler intirinsik, ekstrinsik ve travmatik olabilmektedir. Literatürde rotator manşet yırtıklarının nedenlerini araştıran çok sayıda çalışma mevcuttur. Çalışmalarda lateral akromial açı, akromial indeks ve kritik omuz açısı gibi oran ve açılar ölçülmüş olup bunların RMY ile ilişkisi sorgulanmıştır. Bu değerler dışında çalışmamızda litaratürde daha önce bahsedilmemiş olan 'subakromial indeks' olarak tariflediğimiz ölçümümüzü gerçekleştirdik. Çalışmamızda bu dört ölçüm değerinin spesifite ve sensitivite oranlarının bulunmasını hedefledik. 2013-2021 yılları arasında Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi'ne başvurmuş 35-60 yaş arasındaki hastaların omuz manyetik rezonans (MR) görüntülerine ve raporlarına ulaşıldı. Belirtilen tarihler arasında çekilmiş 500 omuz MR görüntüsü tarandı. Hastalar MR, direkt görüntüleme ve radyoloji raporları üzerinden yapılan incelemeler sonucu rotator manşet yırtığı olan [(RMY (+)] ve olmayan [RMY(-)] olarak iki gruba ayrıldı. Rotator manşet yırtığı olan hastalarda akromial indeks, kritik omuz açısı, lateral akromial açı ve subakromial indeks ölçümleri yapıldı. Aynı parametreler kontrol grubunda da ölçülerek vaka kontrol çalışması yapılması adına istatistiksel olarak incelendi. İstatistiksel olarak RMY(-) kişiler ile RMY(+) hastalar arasında yaş (p<0.001), cinsiyet (p=0.004), akromial indeks (p=0.009), kritik omuz açısı (p=0.006), subakromial indeks (p=0.003), humeroglenoidal mesafe (p=0.029) ve akromiohumeral mesafe (p=0.002) değerleri arasında anlamlı farklılık tespit edildi. Bu sonuçlara göre RMY(+) hastaların, RMY(-) kişilere göre yaşlarının daha ileri, akromial indeks ve kritik omuz açısı ölçüm değerlerinin daha yüksek, buna karşılık subakromial indeks, humeroglenoidal mesafe ve akromiohumeral mesafe ölçüm değerlerinin daha düşük olduğu bulundu. Ayrıca RMY tanısının daha çok kadın hastalarda konulduğu saptandı. ROC-Curve analizi sonucunda yaş >47 yıl ise (p<0.001, duyarlılık %77özgüllük %70), kadın cinsiyet ise (p=0.013, duyarlılık %66, özgüllük %60), akromial indeks değeri >0.58 ise (p=0.009, duyarlılık %60, özgüllük %63), kritik omuz açısı değeri >30.55 ise (p=0.006, duyarlılık %59, özgüllük %63), subakromial indeks değeri <0.58 ise (p=0.003, duyarlılık %60, özgüllük %64) ve akromiohumeral mesafe değeri <25.75 ise (p=0.003, duyarlılık %64, özgüllük %66) bu hastalarda RMY tanısının öngörülebileceği varsayıldı. Logistic Regresyon analizi sonunda yaş (p<0.001) ve akromial indeksin (p<0.014) rotator manşet yırtığını öngörebilmede en iyi parametre olabileceği bulundu. Fakat demografik veri olan yaş ve cinsiyet parametreleri ve subakromial indeksi oluşturan alt ölçüm parametreleri analiz dışı bırakılıp diğer çalışma parametrelerine Logistic Regression analizi uygulandığında subakromial indeks parametresinin RMY tanısı tahmininde "en iyi belirteç" olarak kullanılabileceği tespit edildi (p<0.004).
The etiology of rotator cuff tears (RCT) is multifactorial. These factors can be intrinsic, extrinsic and traumatic. There are many studies in the literature investigating the causes of rotator cuff pathologies. In studies, ratios and angles such as lateral acromion angle, acetabular index and critical shoulder angle were measured and their relationship with RCT was questioned. Apart from these values, we performed our measurement, which we defined as the subacromial index, which has not been mentioned before in the literature. In our study, we aimed to find the specificity and sensitivity ratios of these four measurement values. Shoulder magnetic resonance (MR) images and reports of patients aged 35-60 years who applied to Kırıkkale University Medical Faculty Hospital between 2013-2021 were accessed. 500 shoulder MR images taken between the specified dates were scanned. The patients were divided into two groups as [(RCT (+)] and non-[RCT(-)]) with rotator cuff tear as a result of the examinations performed on MRI, direct imaging and radiology reports. In patients with rotator cuff tear, acromial index, critical shoulder angle, lateral acromial angle and subacromial index measurements were made. The same parameters were also measured in the control group and statistically analyzed to make a case control study. Statistically, age (p<0.001), gender (p=0.004), acromial index (p=0.009), critical shoulder angle (p=0.006), subacromial index (p=) between RCT(-) and RCT(+) patients 0.003), humeroglenoidal distance (p=0.029) and acromiohumeral distance (p=0.002) values were significantly different. According to these results, it was found that RCT(+) patients were older than RCT(-) patients, their acromial index and critical shoulder angle measurement values were higher, whereas subacromial index, humeroglenoidal distance and acromiohumeral distance measurement values were lower. In addition, it was found that the diagnosis of RCT was made mostly in female patients. As a result of ROC-Curve analysis, if age is >47 years (p<0.001, sensitivity 77%, specificity 70%), female gender (p=0.013, sensitivity 66%, specificity 60%), acromial index value >0.58 (p= 0.009, sensitivity 60%, specificity 63%), critical shoulder angle value >30.55 (p=0.006, sensitivity 59%, specificity 63%), subacromial index value <0.58 (p=0.003, sensitivity 60%, specificity 64%) ) and the acromiohumeral distance value was <25.75 (p=0.003, sensitivity 64%, specificity 66%), it was assumed that the diagnosis of RMY could be predicted in these patients. At the end of Logistic Regression analysis, age (p<0.001) and acromial index (p<0.014) were found to be the best parameters to predict rotator cuff tear. However, it was thought that the subacromial index parameter could be used as the "best predictor" in estimating the diagnosis of RCT when the demographic data, age and gender parameters, and the sub-measurement parameters constituting the subacromial index were excluded from the analysis and Logistic Regression analysis was applied to other study parameters (p<0.004).
The etiology of rotator cuff tears (RCT) is multifactorial. These factors can be intrinsic, extrinsic and traumatic. There are many studies in the literature investigating the causes of rotator cuff pathologies. In studies, ratios and angles such as lateral acromion angle, acetabular index and critical shoulder angle were measured and their relationship with RCT was questioned. Apart from these values, we performed our measurement, which we defined as the subacromial index, which has not been mentioned before in the literature. In our study, we aimed to find the specificity and sensitivity ratios of these four measurement values. Shoulder magnetic resonance (MR) images and reports of patients aged 35-60 years who applied to Kırıkkale University Medical Faculty Hospital between 2013-2021 were accessed. 500 shoulder MR images taken between the specified dates were scanned. The patients were divided into two groups as [(RCT (+)] and non-[RCT(-)]) with rotator cuff tear as a result of the examinations performed on MRI, direct imaging and radiology reports. In patients with rotator cuff tear, acromial index, critical shoulder angle, lateral acromial angle and subacromial index measurements were made. The same parameters were also measured in the control group and statistically analyzed to make a case control study. Statistically, age (p<0.001), gender (p=0.004), acromial index (p=0.009), critical shoulder angle (p=0.006), subacromial index (p=) between RCT(-) and RCT(+) patients 0.003), humeroglenoidal distance (p=0.029) and acromiohumeral distance (p=0.002) values were significantly different. According to these results, it was found that RCT(+) patients were older than RCT(-) patients, their acromial index and critical shoulder angle measurement values were higher, whereas subacromial index, humeroglenoidal distance and acromiohumeral distance measurement values were lower. In addition, it was found that the diagnosis of RCT was made mostly in female patients. As a result of ROC-Curve analysis, if age is >47 years (p<0.001, sensitivity 77%, specificity 70%), female gender (p=0.013, sensitivity 66%, specificity 60%), acromial index value >0.58 (p= 0.009, sensitivity 60%, specificity 63%), critical shoulder angle value >30.55 (p=0.006, sensitivity 59%, specificity 63%), subacromial index value <0.58 (p=0.003, sensitivity 60%, specificity 64%) ) and the acromiohumeral distance value was <25.75 (p=0.003, sensitivity 64%, specificity 66%), it was assumed that the diagnosis of RMY could be predicted in these patients. At the end of Logistic Regression analysis, age (p<0.001) and acromial index (p<0.014) were found to be the best parameters to predict rotator cuff tear. However, it was thought that the subacromial index parameter could be used as the "best predictor" in estimating the diagnosis of RCT when the demographic data, age and gender parameters, and the sub-measurement parameters constituting the subacromial index were excluded from the analysis and Logistic Regression analysis was applied to other study parameters (p<0.004).
Açıklama
Tıp Fakültesi, Ortopedi ve Travmatoloji Ana Bilim Dalı
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology
