关节镜下与开放性肩袖修复术的比较

A comparison of arthroscopic and open rotator cuff repair.

作者信息

Ide Junji, Maeda Satoshi, Takagi Katsumasa

机构信息

Department of Orthopaedic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Arthroscopy. 2005 Sep;21(9):1090-8. doi: 10.1016/j.arthro.2005.05.010.

DOI:10.1016/j.arthro.2005.05.010

PMID:16171634

Abstract

PURPOSE

The purpose of this study was to compare the results of all-arthroscopic repair of full-thickness rotator cuff tears including massive tear with those of open repair.

TYPE OF STUDY

Nonrandomized control study.

METHODS

We evaluated 100 consecutive patients (100 shoulders) who were treated for full-thickness rotator cuff tears either by all-arthroscopic (50 patients) or open repair (50 patients). The mean age was 57 years (range, 24 to 78 years). The mean follow-up period was 49 months (range, 25 to 83 months). Of all the patients, 7 had a small tear, 63 a medium tear, 17 a large tear, and 13 a massive tear; in the arthroscopic group, 5 had a small tear, 28 a medium tear, 9 a large tear, and 8 a massive tear. The results of the arthroscopic and open groups were compared using the shoulder rating scale of the University of California at Los Angeles (UCLA) and the Japanese Orthopaedic Association (JOA).

RESULTS

The 2 groups were statistically similar in terms of age, gender, trauma incidence, tear size, duration of symptoms, and preoperative shoulder scores. The UCLA and JOA scores improved significantly in both groups postoperatively. Outcomes and the postoperative UCLA and JOA scores were not significantly different between the 2 groups. The postoperative UCLA and JOA scores in patients with a large-to-massive tear were significantly lower than those with a small-to-medium tear, but outcomes were not statistically different between the arthroscopic and open groups depending on the tear size. The percentage of satisfactory results of arthroscopic and open repair for small-to-medium tears was 97.0% and 94.6%, respectively. Those of arthroscopic and open repair for large-to-massive tears was 82.4% and 76.9%, respectively.

CONCLUSIONS

Arthroscopic repair of small-to-massive tears had outcomes equivalent to those of open repair. Outcomes in patients with large-to-massive tears were inferior to those in patients with small-to-medium tears, regardless of repair method.

LEVEL OF EVIDENCE

Level III, case-control study.

摘要

目的

本研究旨在比较全关节镜修复包括巨大撕裂在内的全层肩袖撕裂的结果与开放修复的结果。

研究类型

非随机对照研究。

方法

我们评估了连续100例因全层肩袖撕裂接受治疗的患者（100个肩部），其中50例采用全关节镜修复，50例采用开放修复。平均年龄为57岁（范围24至78岁）。平均随访期为49个月（范围25至83个月）。所有患者中，7例为小撕裂，63例为中度撕裂，17例为大撕裂，13例为巨大撕裂；关节镜组中，5例为小撕裂，28例为中度撕裂，9例为大撕裂，8例为巨大撕裂。使用加利福尼亚大学洛杉矶分校（UCLA）和日本骨科协会（JOA）的肩部评分量表比较关节镜组和开放组的结果。

结果

两组在年龄、性别、创伤发生率、撕裂大小、症状持续时间和术前肩部评分方面在统计学上相似。两组术后UCLA和JOA评分均显著改善。两组的结果以及术后UCLA和JOA评分无显著差异。大至巨大撕裂患者的术后UCLA和JOA评分显著低于小至中度撕裂患者，但根据撕裂大小，关节镜组和开放组的结果在统计学上无差异。小至中度撕裂的关节镜修复和开放修复的满意结果百分比分别为97.0%和94.6%。大至巨大撕裂的关节镜修复和开放修复的满意结果百分比分别为82.4%和76.9%。