Department of Orthopedic Surgery, Konkuk University Hospital, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, South Korea.
Clin Orthop Relat Res. 2010 Jun;468(6):1578-87. doi: 10.1007/s11999-009-0990-8. Epub 2009 Jul 23.
Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
生物力学研究表明，缝线桥接技术可增加肩袖肌腱止点的接触面积、持力强度和平均接触压力。基于这些研究，我们提出以下假设：（1）缝线桥接技术是否会提高术后肩袖的完整性；（2）修复后的肩袖状态是否会随时间而改变；（3）术前因素能否预测术后肩袖的完整性；（4）与修复完整的患者相比，肩袖再撕裂患者的疼痛、功能评分、活动范围（ROM）和肌肉力量是否较差。我们前瞻性地随访了 78 例接受关节镜修复术的患者，术中我们采用了缝线桥接技术。术后 4.5 个月和 12 个月，通过超声评估确定肩袖修复的完整性。术后 4.5 个月，超声显示肩袖完整的患者占 91%，所有患者在 12 个月的随访中均保持完整。巨大撕裂的失败率为 17.6%（3/17），大撕裂的失败率为 11.1%（2/18），中撕裂的失败率为 6.3%（2/32），小撕裂无失败病例。术前冈上肌脂肪变性是肩袖完整性的一个强有力的预测因素。我们发现，除了在 6 个月时外展力量暂时下降外，肩袖完整性与临床结果之间没有相关性。关节镜下采用缝线桥接技术修复肩袖撕裂可获得较低的再撕裂率，但再撕裂的发生并不影响结果。
IV 级，治疗性研究。有关证据等级的完整描述，请参见作者指南。
