Rokito A S, Cuomo F, Gallagher M A, Zuckerman J D
Department of Orthopaedic Surgery, New York University, Hospital for Joint Diseases, New York City 10003, USA,
J Bone Joint Surg Am. 1999 Jul;81(7):991-7. doi: 10.2106/00004623-199907000-00012.
There have been conflicting reports regarding the effect of the size of a tear of the rotator cuff on the ultimate functional outcome after repair of the rotator cuff. While some authors have reported that the size of the tear does not adversely affect the overall result of repair, others have reported that the outcome is less predictable after repair of a large tear than after repair of a small tear. The purpose of the present study was to examine the long-term functional outcome and the recovery of strength in thirty consecutive patients who had had repair of a large or massive tear of the rotator cuff.
Thirty consecutive patients who had operative repair of a large or massive chronic tear of the rotator cuff had a comprehensive isokinetic assessment of the strength of the shoulder preoperatively, twelve months postoperatively, and a mean of sixty-five months (range, forty-six to ninety-three months) postoperatively. The functional outcome was assessed with the University of California at Los Angeles shoulder score.
All patients reported that they were satisfied with the result and had increased strength compared with preoperatively. There was a significant decrease in pain (p < 0.01) and significant improvements in function (p < 0.01) and the range of motion (p < 0.01). The mean University of California at Los Angeles shoulder score increased significantly from 12.3 points preoperatively to 31.0 points at the most recent follow-up examination (p < 0.01). The mean peak torque in flexion, abduction, and external rotation increased significantly to 80 percent (p < 0.01), 73 percent (p < 0.01), and 91 percent (p < 0.01), respectively, of that of the uninvolved shoulder by the time of the most recent follow-up examination.
Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. The results of the present study suggest that more than one year is needed for complete restoration of strength. The strength of the affected shoulders still did not equal that of the unaffected, contralateral shoulders by the time of the long-term follow-up.
关于肩袖撕裂大小对肩袖修复术后最终功能结果的影响，已有相互矛盾的报道。一些作者报告称，撕裂大小不会对修复的总体结果产生不利影响，而另一些作者则报告称，大撕裂修复后的结果比小撕裂修复后的结果更难预测。本研究的目的是检查连续30例肩袖大撕裂或巨大撕裂修复患者的长期功能结果和力量恢复情况。
连续30例接受肩袖大的或巨大慢性撕裂手术修复的患者，在术前、术后12个月以及术后平均65个月（范围46至93个月）对肩部力量进行了全面的等速评估。使用加利福尼亚大学洛杉矶分校肩评分来评估功能结果。
所有患者均报告对结果满意，且与术前相比力量有所增加。疼痛显著减轻（p < 0.01），功能（p < 0.01）和活动范围（p < 0.01）显著改善。加利福尼亚大学洛杉矶分校肩评分的平均值从术前的12.3分显著提高到最近一次随访检查时的31.0分（p < 0.01）。到最近一次随访检查时，屈曲、外展和外旋的平均峰值扭矩分别显著增加到未受影响肩部的80%（p < 0.01）、73%（p < 0.01）和91%（p < 0.01）。
肩袖大撕裂或巨大撕裂的修复可获得令人满意的长期结果。本研究结果表明，力量完全恢复需要一年以上时间。在长期随访时，患侧肩部的力量仍不及未受影响的对侧肩部。
