Merolla Giovanni, Paladini Paolo, Saporito Marco, Porcellini Giuseppe
Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica - Italy.
Muscles Ligaments Tendons J. 2011 Oct 30;1(1):12-9. Print 2011 Jan.
Rotator cuff tears are a common cause of pain and shoulder dysfunction. The prevalence of the rotator cuff tears increases with the age reaching the 80% in patients aged more than 80 year. Symptomatic shoulders usually are initially treated conservatively and then, in case of poor outcomes, with surgery. Different parameters are still used to decide between the conservative or surgical treatment in patients with rotator cuff tears. Aim of the current study is to characterize the various features used in decision making and to validate a "Prediction Score" that let us know which patients could have a good and stable outcome with non operative treatment. We enrolled 60 patients (mean age 52 years) with symptomatic rotator cuff tears who were assigned to conservative treatment and were evaluated at 6,9 and 12 months follow-up. We developed a score based on 18 clinical and radiographic parameters. 27 patients ("non conservative") (45%) with a mean prediction score of 16.1 ± 1.7 interrupted the conservative treatment, while 33 patients ("conservative") (55%) with an average prediction score of 11.3 ± 1.8 remained conservatively treated at last follow-up. The conservative patients were 14 years older than non conservative patients. According to the results of this study we identified a value of 13 points as a "cut-off" score to predict good results by conservative management of rotator cuff tear. These outcomes support the assumption that a predictive prognostic score may guarantee a rational approach in the management of subjects with RC tears, especially in elderly who continue to have the higher rate of recurrence and therefore could be well treated with standard conservative therapies.
肩袖撕裂是疼痛和肩部功能障碍的常见原因。肩袖撕裂的患病率随年龄增长而增加，80岁以上患者中患病率达80%。有症状的肩部通常最初采用保守治疗，若效果不佳则进行手术。在肩袖撕裂患者中，仍使用不同参数来决定采用保守治疗还是手术治疗。本研究的目的是描述决策过程中使用的各种特征，并验证一个“预测评分”，该评分能让我们了解哪些患者采用非手术治疗可获得良好且稳定的结果。我们纳入了60例有症状的肩袖撕裂患者（平均年龄52岁），这些患者被分配接受保守治疗，并在6个月、9个月和12个月的随访中进行评估。我们基于18个临床和影像学参数制定了一个评分。27例患者（“非保守组”）（45%）平均预测评分为16.1±1.7，中断了保守治疗，而33例患者（“保守组”）（55%）平均预测评分为11.3±1.8，在最后一次随访时仍接受保守治疗。保守组患者比非保守组患者大14岁。根据本研究结果，我们确定13分作为“临界”评分，以预测肩袖撕裂保守治疗的良好结果。这些结果支持这样一种假设，即预测性预后评分可保证对肩袖撕裂患者进行合理治疗，尤其是对于复发率仍然较高的老年人，因此采用标准保守治疗可能效果良好。
