Buess Eduard, Steuber Kai-Uwe, Waibl Bernhard
Orthopaedic Department, Regional Hospital Tafers, Fribourg, Switzerland.
Arthroscopy. 2005 May;21(5):597-604. doi: 10.1016/j.arthro.2005.01.002.
This study was performed to review and compare the outcome of a consecutive series of 96 rotator cuff repairs performed with an open versus arthroscopic technique. The arthroscopic repairs include the beginning of the learning curve.
Case series.
In a 24-month period from 1999 to 2001, 95 patients underwent a cuff repair with bony reattachment by 1 surgeon; 4 patients had surgery on both shoulders. We present subjective outcome data from 96 of 99 operated shoulders by the use of a visual analog scale (VAS), the Simple Shoulder Test (SST), and the question of overall patient satisfaction. Thirty shoulders undergoing surgery before February 2000 had open cuff repair (12 classic open, 18 mini-open) and 66 shoulders undergoing surgery after February 2000 had an arthroscopic cuff repair with suture anchors. All but 3 shoulders had the supraspinatus/infraspinatus tendon refixed, 32% had a subscapularis reattachment, and 21% an additional SLAP repair.
Groups A (30 shoulders, open repair) and B (66 shoulders, arthroscopic repair) were comparable concerning tear size, cause of the tear, professional shoulder strain, and preoperative pain intensity. At follow-up evaluation (15-40 months after surgery), group B had significantly better pain relief on the VAS (P < .05), more yes answers in the SST (9.7 vs. 8.7, not significant), and a higher patient satisfaction rate of 92.4% versus 80% (not significant). From the 12 questions of the SST, all but 1 showed a higher percentage of yes answers in group B; for 3 questions concerning mobility the difference was significant (P < .07). There was no correlation between tear size and outcome in the SST.
Arthroscopic cuff repair yielded equal or better results than open repair, even at the beginning of the learning curve. Patients with an arthroscopic repair had a significantly better decrease in pain and a better functional result concerning mobility. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might even benefit more than small ones.
Level IV.
本研究旨在回顾和比较采用开放技术与关节镜技术连续进行的96例肩袖修复手术的结果。关节镜修复手术涵盖了学习曲线的起始阶段。
病例系列研究。
在1999年至2001年的24个月期间，1名外科医生为95例患者进行了肩袖修复并伴有骨重新附着；4例患者双侧肩部均接受了手术。我们通过视觉模拟量表（VAS）、简易肩部测试（SST）以及患者总体满意度问题，呈现了99例手术肩部中96例的主观结果数据。2000年2月之前接受手术的30例肩部采用开放肩袖修复（12例经典开放手术，18例小切口开放手术），2000年2月之后接受手术的66例肩部采用带缝线锚钉的关节镜肩袖修复。除3例肩部外，其余所有肩部均对冈上肌/冈下肌腱进行了重新固定，32%的患者进行了肩胛下肌重新附着，21%的患者额外进行了SLAP修复。
A组（30例肩部，开放修复）和B组（66例肩部，关节镜修复）在撕裂大小、撕裂原因、职业性肩部劳损以及术前疼痛强度方面具有可比性。在随访评估（术后15 - 40个月）时，B组在VAS上的疼痛缓解情况显著更好（P < 0.05），SST中回答“是”的比例更高（9.7对8.7，无显著差异），患者满意度更高，分别为92.4%和80%（无显著差异）。在SST的12个问题中，除1个问题外，B组回答“是”的比例均更高；对于3个关于活动度的问题，差异具有显著性（P < 0.07）。SST中的结果与撕裂大小之间无相关性。
即使在学习曲线的起始阶段，关节镜肩袖修复的效果与开放修复相当或更好。接受关节镜修复的患者疼痛缓解更为显著，在活动度方面的功能结果更好。关节镜修复对于大小撕裂均有效。从生物力学角度来看，大撕裂可能比小撕裂获益更多。
四级。
