Department of Orthopaedics, Hakone National Hospital, 412 Kazamatsuri, Odawara, Kanagawa 250-0032, Japan.
Clin Orthop Relat Res. 2011 Sep;469(9):2452-60. doi: 10.1007/s11999-011-1896-9.
In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4.
QUESTIONS/PURPOSES: We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively.
We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively.
Patients with Grade 3, 4, or 5 tears had a higher incidence of fatty muscle degeneration of the subscapularis muscle than patients with Grade 1 or 2 tears. In 26 patients with Grade 1 or 2 tears at initial examination, duration of followup was longer in patients who remained at Grade 1 or 2 than in those who progressed to Grade 3, 4, or 5 at final followup. The retear rate of repaired supraspinatus tendon was more frequent in Grade 2 than Grade 1 tears. In operated cases, radiographic grades at final followup did not develop to Grades 3 to 5.
We believe cuff repair should be performed before acromiohumeral interval narrowing. Our observations are consistent with the temporal concepts of massive cuff tear pathomechanics proposed by Burkhart and Hansen et al.
Level III, Therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
1990 年，Hamada 等人对肩袖巨大撕裂进行了 X 线分级，Walch 等人随后将 4 级进一步细分，以反映肩峰下关节炎的存在/不存在，并强调 4 级的特征是肱骨头关节炎。
问题/目的：因此，我们确定（1）在初次检查和最终随访时，各等级患者的特征和 MRI 表现是否存在差异；（2）哪些因素会影响进展为更高等级；（3）修复肌腱的再撕裂率在各等级之间是否存在差异；（4）手术治疗的患者在最终随访时的 X 线分级是否与初次检查时的分级存在差异。
我们回顾性分析了 75 例肩袖巨大撕裂患者。34 例患者接受非手术治疗，41 例患者接受手术治疗。
与 1 级或 2 级撕裂患者相比，3 级、4 级或 5 级撕裂患者的肩胛下肌的脂肪肌肉变性发生率更高。在初次检查时为 1 级或 2 级的 26 例患者中，在最终随访时仍为 1 级或 2 级的患者随访时间更长，而进展为 3 级、4 级或 5 级的患者随访时间更短。修复的冈上肌腱的再撕裂率在 2 级比 1 级撕裂更常见。在手术治疗的病例中，最终随访时的 X 线分级未发展为 3 级至 5 级。
我们认为在肩峰肱骨关节间隙变窄之前应进行肩袖修复。我们的观察结果与 Burkhart 和 Hansen 等人提出的肩袖巨大撕裂病理力学的时间概念一致。
III 级，治疗研究。完整的证据等级描述请参见作者指南。
