Ide Junji, Tokiyoshi Akinari, Hirose Jun, Mizuta Hiroshi
Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556, Japan.
J Bone Joint Surg Am. 2007 Nov;89(11):2378-88. doi: 10.2106/JBJS.G.00082.
Although the use of arthroscopic repair to treat rotator cuff tears involving the subscapularis has increased, there are few studies on treatment outcomes and repair integrity. We hypothesized that arthroscopic repair of combined rotator cuff tears that include the subscapularis yields successful functional and structural outcomes.
Our study population consisted of seventeen men and three women (twenty shoulders) whose mean age was 61.7 years. The mean duration of follow-up was 36.1 months, and all patients were followed for at least two years. All had traumatic full-thickness tears of the subscapularis and supraspinatus, and seven had a concomitant infraspinatus tear. The mean time from the injury to the surgery was 2.7 months. An arthroscopic suture-anchor technique was used for the repair. The shoulders were evaluated before and after the procedure with use of the University of California at Los Angeles (UCLA) score, the Japanese Orthopaedic Association (JOA) score, plain radiographs, and magnetic resonance imaging scans.
After arthroscopic repair, the mean UCLA and JOA scores significantly improved from 14.9 and 55.7 points to 31.1 and 91.0 points, respectively (p < 0.0001). According to the JOA rating scale, the outcome was excellent for thirteen patients (65%), good for five (25%), fair for one (5%), and poor for one (5%). Of the twenty patients, seven (35%) had recurrent tears after the surgery; four of them had originally had a three-tendon tear and the other three had had a two-tendon tear. Of these seven patients, one had an excellent outcome; five, a good outcome; and one, a fair outcome. The postoperative mean JOA score was significantly lower for the patients with a failed repair than it was for those with an intact repair (p = 0.0034). The patients with a failed repair also had a significantly higher mean age (68.4 years compared with 58.1 years for those with an intact repair; p = 0.014), and the prevalence of recurrent tears was significantly higher in the patients with severe tendon retraction compared with those with minimal or moderate tendon retraction (p = 0.0191).
Arthroscopic repair with use of the suture anchor technique is a safe and effective procedure for the treatment of combined rotator cuff tears involving the subscapularis tendon; it can alleviate shoulder pain and improve function and the range of motion. The postoperative integrity of the repair correlates with the clinical results. Patient age and the degree of tendon retraction can affect the integrity of the repair.
尽管使用关节镜修复治疗累及肩胛下肌的肩袖撕裂的情况有所增加，但关于治疗效果和修复完整性的研究较少。我们假设，对包括肩胛下肌在内的复合性肩袖撕裂进行关节镜修复可产生成功的功能和结构结果。
我们的研究对象包括17名男性和3名女性（共20个肩关节），平均年龄为61.7岁。平均随访时间为36.1个月，所有患者均随访至少两年。所有患者均有肩胛下肌和冈上肌的创伤性全层撕裂，7例伴有冈下肌撕裂。受伤至手术的平均时间为2.7个月。采用关节镜缝线锚钉技术进行修复。在手术前后，使用加州大学洛杉矶分校（UCLA）评分、日本骨科协会（JOA）评分、X线平片和磁共振成像扫描对肩关节进行评估。
关节镜修复后，UCLA评分和JOA评分的平均值分别从14.9分和55.7分显著提高至31.1分和91.0分（p < 0.0001）。根据JOA评级标准，13例患者（65%）结果为优，5例（25%）为良，1例（5%）为可，1例（5%）为差。20例患者中，7例（35%）术后出现复发性撕裂；其中4例最初为三肌腱撕裂，另外3例为双肌腱撕裂。这7例患者中，1例结果为优；5例为良；1例为可。修复失败的患者术后平均JOA评分显著低于修复完好的患者（p = 0.0034）。修复失败的患者平均年龄也显著更高（68.4岁，而修复完好的患者为58.1岁；p = 0.014），与肌腱回缩轻微或中度的患者相比，肌腱严重回缩的患者复发性撕裂的发生率显著更高（p = 0.0191）。
使用缝线锚钉技术进行关节镜修复是治疗累及肩胛下肌腱的复合性肩袖撕裂的一种安全有效的方法；它可以减轻肩部疼痛，改善功能和活动范围。修复的术后完整性与临床结果相关。患者年龄和肌腱回缩程度会影响修复的完整性。
