Zumstein Matthias A, Jost Bernhard, Hempel Julia, Hodler Juerg, Gerber Christian
Department of Orthopedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
J Bone Joint Surg Am. 2008 Nov;90(11):2423-31. doi: 10.2106/JBJS.G.00677.
At a mean follow-up of 3.1 years, twenty-seven consecutive repairs of massive rotator cuff tears yielded good and excellent clinical results despite a retear rate of 37%. Patients with a retear had improvement over the preoperative state, but those with a structurally intact repair had a substantially better result. The purpose of this study was to reassess the same patients to determine the long-term functional and structural results.
At a mean follow-up interval of 9.9 years, twenty-three of the twenty-seven patients returned for a review and were examined clinically, radiographically, and with magnetic resonance imaging with use of a methodology identical to that used at 3.1 years.
Twenty-two of the twenty-three patients remained very satisfied or satisfied with the result. The mean subjective shoulder value was 82% (compared with 80% at 3.1 years). The mean relative Constant score was 85% (compared with 83% at 3.1 years). The retear rate was 57% at 9.9 years (compared with 37% at 3.1 years; p = 0.168). Patients with an intact repair had a better result than those with a failed reconstruction with respect to the mean absolute Constant score (81 compared with 64 points, respectively; p = 0.015), mean relative Constant score (95% and 77%; p = 0.002), and mean strength of abduction (5.5 and 2.6 kg; p = 0.007). The mean retear size had increased from 882 to 1164 mm(2) (p = 0.016). Supraspinatus and infraspinatus muscle fatty infiltration had increased (p = 0.004 and 0.008, respectively). Muscles with torn tendons preoperatively showed more fatty infiltration than muscles with intact tendons preoperatively, regardless of repair integrity. Shoulders with a retear had a significantly higher mean acromion index than those without retear (0.75 and 0.65, respectively; p = 0.004).
Open repair of massive rotator cuff tears yielded clinically durable, excellent results with high patient satisfaction at a mean of almost ten years postoperatively. Conversely, fatty muscle infiltration of the supraspinatus and infraspinatus progressed, and the retear size increased over time. The preoperative integrity of the tendon appeared to be protective against muscle deterioration. A wide lateral extension of the acromion was identified as a previously unknown risk factor for retearing.
在平均3.1年的随访中，连续27例巨大肩袖撕裂修补术取得了良好和优异的临床效果，尽管再撕裂率为37%。再撕裂的患者较术前状态有所改善，但结构完整的修补患者结果明显更好。本研究的目的是对同一批患者进行重新评估，以确定长期的功能和结构结果。
在平均9.9年的随访间隔时，27例患者中有23例返回接受复查，并进行了临床、影像学和磁共振成像检查，采用的方法与3.1年时相同。
23例患者中有22例对结果仍非常满意或满意。主观肩关节评价值平均为82%（3.1年时为80%）。相对Constant评分平均为85%（3.1年时为83%）。9.9年时再撕裂率为57%（3.1年时为37%；p = 0.168）。就绝对Constant评分平均值（分别为81分和64分；p = 0.015）、相对Constant评分平均值（95%和77%；p = 0.002）以及外展平均力量（5.5 kg和2.6 kg；p = 0.007）而言，修补完整的患者比重建失败的患者结果更好。再撕裂平均大小从882平方毫米增加到1164平方毫米（p = 0.016）。冈上肌和冈下肌脂肪浸润增加（分别为p = 0.004和0.008）。无论修补是否完整，术前肌腱撕裂的肌肉比术前肌腱完整的肌肉脂肪浸润更多。有再撕裂的肩关节平均肩峰指数显著高于无再撕裂的肩关节（分别为0.75和0.65；p = 0.004）。
巨大肩袖撕裂的开放修补术在术后平均近十年时取得了临床持久、优异的效果，患者满意度高。相反，冈上肌和冈下肌的脂肪浸润进展，再撕裂大小随时间增加。术前肌腱的完整性似乎对肌肉退变有保护作用。肩峰外侧广泛延伸被确定为一种此前未知的再撕裂危险因素。
