Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario N6A 4L6, Canada.
Arthroscopy. 2010 Mar;26(3):310-5. doi: 10.1016/j.arthro.2009.08.015. Epub 2010 Jan 25.
The purpose of this study was to identify the incidence of metallic suture anchor pullout after arthroscopic rotator cuff repair and determine the impact of tear size on the risk of pullout.
A retrospective review of 269 patients (550 metallic suture anchors) who underwent arthroscopic rotator cuff repair between January 2006 and January 2009 was conducted. Inclusion criteria included patients aged 18 years or older, a minimum of 6 weeks' radiographic follow-up, and the use of 1 or more metallic suture anchors for partial or complete rotator cuff repair. The mean age of the cohort at the time of surgery was 55 years (range, 29 to 86 years), and there were 189 men and 80 women.
Early anchor pullout occurred in 6 patients (9 anchors). The overall incidence of early metallic suture anchor pullout in this cohort was 2.4% (95% confidence interval, 0.5% to 4.3%). The incidence in rotator cuff tears less than or equal to 3 cm was 0.5%, and the incidence in tears greater than 3 cm was 11%. Patients undergoing arthroscopic rotator cuff repair of a tear greater than 3 cm in size were at a significantly higher risk of having early metallic suture anchor pullout than patients undergoing repair of a smaller tear (relative risk, 22; P = .001). Among the 61 patients undergoing arthroscopic subscapularis repair, no suture anchor failures were observed at the lesser tuberosity. Of the 9 anchors that failed, 8 (89%) pulled out of the posterior aspect of the greater tuberosity.
There is a minimal risk of suture anchor pullout in small- to medium-sized tears; however, this risk increases with larger tear sizes. We recommend routine radiographic follow-up after use of metallic anchors to ensure identification of early failure by anchor pullout.
Level III, prognostic case series.
本研究旨在确定关节镜下肩袖修复术后金属缝线锚钉拔出的发生率，并确定撕裂大小对拔出风险的影响。
对 2006 年 1 月至 2009 年 1 月期间接受关节镜下肩袖修复的 269 例患者（550 个金属缝线锚钉）进行回顾性分析。纳入标准为年龄≥18 岁、至少有 6 周的影像学随访，且使用 1 个或多个金属缝线锚钉进行部分或完全肩袖修复。手术时队列的平均年龄为 55 岁（范围 29 岁至 86 岁），其中 189 例为男性，80 例为女性。
6 例（9 个锚钉）发生早期锚钉拔出。该队列中早期金属缝线锚钉拔出的总发生率为 2.4%（95%置信区间，0.5%至 4.3%）。撕裂小于或等于 3cm 的发生率为 0.5%，撕裂大于 3cm 的发生率为 11%。与撕裂较小的患者相比，行撕裂大于 3cm 的关节镜肩袖修复术的患者发生早期金属缝线锚钉拔出的风险显著更高（相对风险，22；P=.001）。在 61 例行关节镜下肩胛下肌修复术的患者中，未见小结节处缝线锚钉失败。在 9 个失败的锚钉中，有 8 个（89%）从大结节后外侧拔出。
在小至中等大小的撕裂中，缝线锚钉拔出的风险很小；然而，随着撕裂尺寸的增大，这种风险会增加。我们建议在使用金属锚钉后进行常规影像学随访，以确保通过锚钉拔出及时发现早期失败。
III 级，预后病例系列研究。
