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单排与双排关节镜下肩袖修补术:一项前瞻性随机临床研究。

Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study.

作者信息

Grasso Andrea, Milano Giuseppe, Salvatore Matteo, Falcone Gianluca, Deriu Laura, Fabbriciani Carlo

机构信息

Villa Valeria Clinic, Rome, Italy.

出版信息

Arthroscopy. 2009 Jan;25(1):4-12. doi: 10.1016/j.arthro.2008.09.018. Epub 2008 Nov 1.

Abstract

PURPOSE

The purpose of this study was to compare the clinical outcome of arthroscopic rotator cuff repair with single-row and double-row techniques.

METHODS

Eighty patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were divided into 2 groups of 40 patients according to repair technique: single row (group 1) or double row (group 2). Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires, normalized Constant score, and muscle strength measurement. On analyzing the results at a 2-year follow-up, we considered the following independent variables: baseline scores; age; gender; dominance; location, shape, and area of cuff tear; tendon retraction; fatty degeneration; treatment of biceps tendon; and rotator cuff repair technique (anchors or anchors and side to side). Univariate and multivariate statistical analyses were performed to determine which variables were independently associated with the outcome. Significance was set at P < .05.

RESULTS

Of the patients, 8 (10%) were lost to follow-up. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, the mean DASH scores were 15.4 +/- 15.6 points in group 1 and 12.7 +/- 10.1 points in group 2; the mean Work-DASH scores were 16.0 +/- 22.0 points and 9.6 +/- 13.3 points, respectively; and the mean Constant scores were 100.5 +/- 17.8 points and 104.9 +/- 21.8 points, respectively. Muscle strength was 12.7 +/- 5.7 lb in group 1 and 12.9 +/- 7.0 lb in group 2. Univariate and multivariate analysis showed that only age, gender, and baseline strength significantly and independently influenced the outcome. Differences between groups 1 and 2 were not significant.

CONCLUSIONS

At short-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair.

LEVEL OF EVIDENCE

Level I, high-quality randomized controlled trial with no statistically significant differences but narrow confidence intervals.

摘要

目的

本研究旨在比较关节镜下采用单排和双排技术修复肩袖的临床疗效。

方法

80例肩袖全层撕裂患者接受了关节镜下缝线锚钉修复术。根据修复技术将他们分为两组,每组40例:单排组(第1组)和双排组(第2组)。采用上肢、肩部和手部功能障碍(DASH)及工作相关DASH自评问卷、标准化Constant评分和肌肉力量测量来评估结果。在对2年随访结果进行分析时,我们考虑了以下自变量:基线评分;年龄;性别;优势侧;肩袖撕裂的位置、形状和面积;肌腱回缩;脂肪变性;肱二头肌肌腱的处理;以及肩袖修复技术(锚钉或锚钉加边对边缝合)。进行单因素和多因素统计分析以确定哪些变量与结果独立相关。显著性设定为P < 0.05。

结果

患者中有8例(10%)失访。两组之间在所考虑的每个变量上均未显示出显著差异。总体而言,根据结果,第1组的平均DASH评分为15.4±15.6分,第2组为12.7±10.1分;平均工作相关DASH评分为16.0±22.0分和9.6±13.3分;平均Constant评分为100.5±17.8分和104.9±21.8分。第1组的肌肉力量为12.7±5.7磅,第2组为12.9±7.0磅。单因素和多因素分析表明,只有年龄、性别和基线力量对结果有显著且独立的影响。第1组和第2组之间的差异不显著。

结论

在短期随访中,关节镜下采用双排技术修复肩袖与单排修复相比临床疗效无显著差异。

证据水平

I级,高质量随机对照试验,无统计学显著差异但置信区间较窄。

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