Institut Ostéo Articulaire Paris Courcelles, 75008 Paris, France.
Arthroscopy. 2010 Mar;26(3):302-9. doi: 10.1016/j.arthro.2009.08.027.
The aim of this study was to assess tendon healing and clinical results of rotator cuff tears (RCTs) repaired arthroscopically in patients aged 65 years or older.
Between January 2001 and December 2004, 88 patients with a mean age of 70 years (range, 65 to 85 years) had arthroscopic RCT repair. The repair was performed on 54 women (61%). The dominant arm was involved in 72 patients (82%). RCT included more than 2 tendons in 45 cases. Functional outcomes were assessed by use of the Constant score and Simple Shoulder Test. Tendon healing was estimated by use of a computed tomography (CT) arthrogram, which was obtained 6 months postoperatively, and was classified into 3 categories: stage 1, watertight and anatomic healing; stage 2, watertight and partial healing; and stage 3, not watertight and retear.
The mean duration of follow-up was 41 months (range, 24 to 77 months). The mean clinical outcome scores all improved significantly at the time of the final follow-up (P < .01). Computed tomography arthrogram imaging showed 27 shoulders with a stage 1 repair, 20 with a stage 2 repair, and 34 with a stage 3 repair. The retear rate was 42% (34 of 81). The patients with tendon healing stage 1 or 2 had a significantly superior functional outcome in terms of overall scores and strength compared with the stage 3 repairs (P < .01). In our study we had 39 isolated supraspinatus tears (small or medium tears); 11 (28.9%) had a retear (stage 3).
Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement. Our data suggest that arthroscopic repair can be considered successful for the older patient specifically when the tear is limited to the supraspinatus tendon.
Level IV, therapeutic case series.
本研究旨在评估年龄在 65 岁及以上的患者行关节镜下修复肩袖撕裂（RCT）的腱愈合和临床结果。
2001 年 1 月至 2004 年 12 月，88 例平均年龄为 70 岁（65 至 85 岁）的患者行关节镜下 RCT 修复。修复术涉及 54 名女性（61%）。72 例患者（82%）为优势臂。45 例 RCT 累及超过 2 根肌腱。使用 Constant 评分和简易肩部测试评估功能结果。术后 6 个月行 CT 关节造影术评估腱愈合情况，分为 3 类：1 期，密闭且解剖愈合；2 期，密闭且部分愈合；3 期，不密闭且再撕裂。
平均随访时间为 41 个月（24 至 77 个月）。最终随访时所有临床评分均显著提高（P<.01）。CT 关节造影显示 27 肩 1 期修复，20 肩 2 期修复，34 肩 3 期修复。再撕裂率为 42%（34/81）。1 期或 2 期腱愈合患者的整体评分和力量均明显优于 3 期修复患者（P<.01）。在我们的研究中，我们有 39 例孤立性冈上肌腱撕裂（小或中等撕裂）；11 例（28.9%）发生再撕裂（3 期）。
年龄在 65 岁及以上的患者行关节镜下修复可获得腱愈合，从而显著改善功能。我们的数据表明，对于撕裂仅限于冈上肌腱的老年患者，关节镜修复可被视为成功的治疗方法。
IV 级，治疗性病例系列。
