Burkhart Stephen S, Barth Johannes R H, Richards David P, Zlatkin Michael B, Larsen Mitchell
Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Arthroscopy. 2007 Apr;23(4):347-54. doi: 10.1016/j.arthro.2006.12.012.
The purpose of this study was to assess the functional results of arthroscopic repair of massive rotator cuff tears in patients who had stage 3 and 4 fatty degeneration of the rotator cuff musculature, according to the Goutallier scale.
From January 1997 to December 2001, 22 patients with massive rotator cuff tears and Goutallier stage 3 or 4 fatty degeneration of the infraspinatus, with a mean age of 66.5 +/- 9.26 years, underwent arthroscopic rotator cuff repair and were available for follow-up. The average tear size was 4.8 +/- 0.85 cm in medial-to-lateral width and 6.2 +/- 1.53 cm in anterior-to-posterior length, with an approximate tear size area of 30.0 +/- 10.0 sq cm, and involved 2 tendons (supraspinatus and infraspinatus) or 3 tendons (supraspinatus, infraspinatus, and subscapularis) in each case. The mean time from surgery to follow-up was 39.3 months (range, 24-60 months). In addition to comparison of preoperative and postoperative range of motion, strength and University of California, Los Angeles (UCLA) score, outcomes were also assessed with the Constant score.
The increase of mean active forward elevation was 53.7 degrees (preoperative: 103.2 degrees and postoperatively: 156.9 degrees ). The gain of mean active external rotation was 19.1 degrees (preoperative: 35.7 degrees and postoperative: 54.8 degrees). The gain of mean external rotation power was 1.9 (preoperative: 2.3 and postoperative: 4.2). The improvement in the UCLA score was 17.2 points (preoperative: 12.3 and postoperative: 29.5). The mean postoperative Constant score was 74.8/100, and the weighted postoperative Constant score was 88.5/100. In 5 patients with fatty degeneration greater than 75% (advanced stage 4), results were less dramatically improved than in 17 patients with fatty degeneration of 50% to 75%, all of whom exhibited clinical improvement. However, clinical improvement was achieved even in 2 of 5 patients with advanced stage 4 involvement.
Arthroscopic rotator cuff repair in patients with grade 3 or 4 fatty degeneration (> or =50%) can provide significant functional improvement. Those with 50% to 75% fatty degeneration showed a much greater degree of improvement (with all 17 cases exhibiting beneficial postoperative increases in their UCLA scores ranging from 12 to 26 points) than those with >75% fatty degeneration (with only 2 of 5 cases showing an increase of 10 or more points in their UCLA scores). However, clinical improvement was observed in 86.4% of cases that would have been classified as likely to fail by the Goutallier criteria.
Level IV, therapeutic case series.
本研究旨在根据Goutallier分级标准，评估肩袖肌肉组织处于3期和4期脂肪变性的患者，接受关节镜下巨大肩袖撕裂修复术后的功能结果。
1997年1月至2001年12月期间，22例巨大肩袖撕裂且冈下肌Goutallier分级为3期或4期脂肪变性的患者接受了关节镜下肩袖修复术，平均年龄为66.5±9.26岁，并进行了随访。平均撕裂宽度为4.8±0.85厘米（内侧到外侧），前后长度为6.2±1.53厘米，撕裂面积约为30.0±10.0平方厘米，每组病例累及2条肌腱（冈上肌和冈下肌）或3条肌腱（冈上肌、冈下肌和肩胛下肌）。手术至随访的平均时间为39.3个月（范围24 - 60个月）。除比较术前和术后的活动范围、力量以及加州大学洛杉矶分校（UCLA）评分外，还用Constant评分评估结果。
平均主动前屈抬高增加了53.7度（术前：103.2度，术后：156.9度）。平均主动外旋增加了19.1度（术前：35.7度，术后：54.8度）。平均外旋力量增加了1.9（术前：2.3，术后：4.2）。UCLA评分提高了17.2分（术前：12.3，术后：29.5）。术后平均Constant评分为74.8/100，加权术后Constant评分为88.5/100。在5例脂肪变性大于75%（4期晚期）的患者中，结果改善程度不如17例脂肪变性为50%至75%的患者显著，所有这些患者均表现出临床改善。然而，在5例4期晚期受累患者中，仍有2例实现了临床改善。
3级或4级脂肪变性（≥50%）患者的关节镜下肩袖修复术可显著改善功能。脂肪变性为50%至75%的患者改善程度更大（17例患者术后UCLA评分均有有益增加，范围为12至26分），大于脂肪变性>75%的患者（5例患者中只有2例UCLA评分增加10分或更多）。然而，根据Goutallier标准，86.4%本可能被归类为预后不佳的病例实现了临床改善。
IV级，治疗性病例系列。
