Charousset C, Duranthon L D, Grimberg J, Bellaiche L
Association Francilienne de Traumatologie du Sport, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 2006 May;92(3):223-33. doi: 10.1016/s0035-1040(06)75729-4.
Arthroscopic repair of rotator cuff tears is a well described technique with good clinical results. The purpose of this work was to use the arthro-CT-scan to evaluate tendon healing after arthroscopic repair and search for epidemiological, anatomic and technical factors predictive of tendon healing.
This prospective consecutive series included 167 non-randomized shoulders. All patients underwent a preoperative assessment using the crude Constant score and a standard x-ray protocol to evaluate cuff status. Cuff repairs were all performed arthroscopically. The crude Constant score was used to follow patients. A control arthroscan was obtained in 148 patients.
Mean patient age was 59 years, 46% men and 77% dominant side. Mean duration of symptoms before repair was nine months. The tears resulted from trauma in 28%, including 9% occupational accidents. The preoperative mean crude Constant score was 52.4 (range 15-77). An isolated tear of the supraspinatus was observed in 68%. Frontal retraction of the supraspinatus was distal in 74%. In 29 cases, reduction was difficult. The quality of the tendon was considered normal in 56 cases and non-anatomic repair was necessary in six. At last follow-up (19 months on average) the mean crude Constant score was 80 (range 49-95). Arthro-CT-scan was performed to control healing in 148 patients and revealed anatomic healing in 69, defective healing in 27, and repeated tears in 52 shoulders. Factors predictive of healing were: tear less than six months old, sedentary occupational activity, non-dominant side, young patient, female gender, isolated small non-retracted tear of the supraspinatus, normal appearance of an easily reduced tendon, and good bone quality.
Time from tear to repair was long in this series. Tendon and muscle changes occurring after the injury could explain in part the healing failures.
But this study confirmed good functional and anatomic results given by arthroscopic repair of rotator cuff tears.
关节镜下修复肩袖撕裂是一种已被充分描述的技术，临床效果良好。本研究的目的是利用关节CT扫描评估关节镜修复术后肌腱的愈合情况，并寻找预测肌腱愈合的流行病学、解剖学和技术因素。
本前瞻性连续系列研究纳入了167例非随机选择的肩部病例。所有患者术前均采用粗略的Constant评分和标准X线检查方案评估肩袖状况。所有肩袖修复均通过关节镜进行。采用粗略的Constant评分对患者进行随访。148例患者进行了对照关节镜扫描。
患者平均年龄为59岁，男性占46%，优势侧占77%。修复前症状的平均持续时间为9个月。28%的撕裂由外伤引起，其中9%为职业事故。术前平均粗略Constant评分为52.4（范围15 - 77）。68%观察到单纯冈上肌撕裂。74%的冈上肌前缘回缩位于远端。29例中复位困难。56例肌腱质量被认为正常，6例需要进行非解剖修复。在最后一次随访时（平均19个月），平均粗略Constant评分为80（范围49 - 95）。148例患者进行关节CT扫描以控制愈合情况，结果显示69例解剖愈合，27例愈合不良，52例肩部再次撕裂。预测愈合的因素包括：撕裂小于6个月、久坐的职业活动、非优势侧、年轻患者、女性、单纯冈上肌小的非回缩性撕裂、易于复位的肌腱外观正常以及骨质良好。
本系列研究中从撕裂到修复的时间较长。损伤后发生的肌腱和肌肉变化可能部分解释愈合失败的原因。
但本研究证实了关节镜下修复肩袖撕裂可获得良好的功能和解剖学结果。
