The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
J Shoulder Elbow Surg. 2013 Mar;22(3):396-402. doi: 10.1016/j.jse.2012.05.031. Epub 2012 Sep 1.
Controversy exists regarding the optimal technique of subscapularis mobilization during shoulder arthroplasty. The purpose of this study was to compare healing rates and subscapularis fatty infiltration in patients undergoing a lesser tuberosity osteotomy (LTO) versus subscapularis peel for exposure during shoulder arthroplasty.
Eighty-seven patients, with a mean age of 67.8 ± 10.9 years, undergoing shoulder arthroplasty, were randomized to receive either an LTO (n = 43) or peel (n = 44). Computed tomography scans were conducted preoperatively and at 12 months postoperatively. Outcome variables included healing rates and subscapularis Goutallier fatty infiltration grade, as well as subscapularis strength and Western Ontario Osteoarthritis of the Shoulder Index and American Shoulder and Elbow Surgeons outcome scores.
Computed tomography imaging was available in 91% (n = 79) of the cohort. The healing rates for the peel (100%) and for the LTO (95%) did not differ significantly (P = .493). Preoperatively, the mean fatty infiltration grade for the peel (mean, 0.53) was not significantly different (P = .925) from the LTO (mean, 0.54). Postoperatively, the Goutallier mean fatty infiltration grade for the peel (mean, 0.95) did not differ significantly (P = .803) from the LTO (mean, 0.9). A significant increase in subscapularis fatty infiltration grade occurred postoperatively from the preoperative status (peel, P = .003; LTO, P = .0002). No statistically significant associations were observed between postoperative fatty infiltration grades and subscapularis strength, Western Ontario Osteoarthritis of the Shoulder Index scores, or American Shoulder and Elbow Surgeons scores.
No statistically significant differences were observed in the healing rates or subscapularis fatty infiltration grades between the peel and the LTO. This trial does not show any clear difference in radiologic and clinical outcomes of one subscapularis management technique over the other.
在肩关节置换术中，关于肩胛下肌动员的最佳技术存在争议。本研究的目的是比较小转子截骨术（LTO）与肩胛下肌皮瓣在肩关节置换术中暴露时的愈合率和肩胛下肌脂肪浸润情况。
87 名平均年龄为 67.8±10.9 岁的患者接受肩关节置换术，随机分为 LTO 组（n=43）和皮瓣组（n=44）。术前和术后 12 个月进行计算机断层扫描。观察指标包括愈合率和肩胛下肌 Goutallier 脂肪浸润分级，以及肩胛下肌力量、Western Ontario 肩关节炎指数和美国肩肘外科协会评分。
91%（n=79）的患者可进行 CT 成像。皮瓣组（100%）和 LTO 组（95%）的愈合率无显著差异（P=0.493）。术前，皮瓣组的平均脂肪浸润分级（平均 0.53）与 LTO 组（平均 0.54）无显著差异（P=0.925）。术后，皮瓣组的 Goutallier 平均脂肪浸润分级（平均 0.95）与 LTO 组（平均 0.9）无显著差异（P=0.803）。术后肩胛下肌脂肪浸润分级较术前显著增加（皮瓣组，P=0.003；LTO 组，P=0.0002）。术后脂肪浸润分级与肩胛下肌力量、Western Ontario 肩关节炎指数评分或美国肩肘外科协会评分之间无显著相关性。
皮瓣组与 LTO 组的愈合率或肩胛下肌脂肪浸润分级无统计学差异。本试验未显示两种肩胛下肌处理技术在影像学和临床结果方面有任何明显差异。
