Djurasovic M, Marra G, Arroyo J S, Pollock R G, Flatow E L, Bigliani L U
Department of Orthopedic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Medical Center, 622 West 168th Street, New York, NY 10032, USA.
J Bone Joint Surg Am. 2001 Dec;83(12):1849-55. doi: 10.2106/00004623-200112000-00013.
Revision rotator cuff repair is a surgical challenge, and the results have generally been inferior to those of primary repair. We examined the results of revision rotator cuff repair in a large series of patients and assessed which subgroups of patients had the greatest chance for a satisfactory functional outcome.
A revision rotator cuff repair was performed in eighty patients after the failure of a previous operative repair. The average age of the patients at the time of the revision was fifty-nine years. Prior to revision, the average pain score was 7.4 points (with 0 points indicating no pain and 10 points, severe pain) and the active range of motion of the shoulder averaged 105 degrees of elevation, 39 degrees of external rotation, and internal rotation to the eleventh thoracic vertebra. All patients underwent repeat repair of the rotator cuff tendons to bone. Additional procedures included revision acromioplasty (fifty-three patients; 66%) and distal clavicular excision (twenty-six patients; 33%), among others.
After an average duration of follow-up of forty-nine months, the result was rated as satisfactory (excellent, good, or fair) in fifty-five patients (69%) and as unsatisfactory (poor) in twenty-five (31%). At the time of the latest follow-up, the average pain score had improved to 3.0 points and the active range of motion averaged 130 degrees of elevation, 53 degrees of external rotation, and internal rotation to the tenth thoracic vertebra. Improved results were associated with an intact deltoid origin, good-quality rotator cuff tissue, preoperative active elevation of the arm above the horizontal, and only one prior procedure. All seventeen patients who met all four of these criteria had a satisfactory result.
The results of revision rotator cuff repair are inferior to those of primary repair. While pain relief can be reliably achieved in most patients, the functional results are improved principally in patients with an intact deltoid origin, good-quality rotator cuff tissue, preoperative elevation above the horizontal, and only one prior procedure.
翻修性肩袖修复术是一项手术挑战，其结果总体上逊于初次修复。我们研究了一大组患者的翻修性肩袖修复术结果，并评估了哪些亚组患者获得满意功能结果的机会最大。
在先前手术修复失败后，对80例患者进行了翻修性肩袖修复术。翻修时患者的平均年龄为59岁。翻修前，平均疼痛评分为7.4分（0分表示无疼痛，10分表示剧痛），肩关节主动活动范围平均为前屈105度、外旋39度和内旋至胸11椎体水平。所有患者均接受了肩袖肌腱至骨的再次修复。其他手术包括翻修肩峰成形术（53例患者；66%）和锁骨远端切除术（26例患者；33%）等。
平均随访49个月后，55例患者（69%）的结果被评为满意（优、良或可），25例患者（31%）的结果被评为不满意（差）。在最近一次随访时，平均疼痛评分改善至3.0分，主动活动范围平均为前屈130度、外旋53度和内旋至胸10椎体水平。结果改善与三角肌起点完整、肩袖组织质量良好、术前手臂主动前屈超过水平位以及仅接受过一次先前手术有关。符合所有这四项标准的17例患者均获得了满意的结果。
翻修性肩袖修复术的结果逊于初次修复。虽然大多数患者能够可靠地实现疼痛缓解，但功能结果主要在三角肌起点完整、肩袖组织质量良好、术前前屈超过水平位且仅接受过一次先前手术的患者中得到改善。
