Namdari Surena, Donegan Ryan P, Dahiya Nirvikar, Galatz Leesa M, Yamaguchi Ken, Keener Jay D
Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA.
Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA.
J Shoulder Elbow Surg. 2014 Jan;23(1):20-7. doi: 10.1016/j.jse.2013.05.015. Epub 2013 Aug 9.
The purpose of this study was to examine the baseline function and results of arthroscopic cuff repair in shoulders with small and medium-sized full-thickness cuff tears with complete supraspinatus disruption compared with those with an intact anterior supraspinatus tendon.
The study evaluated 112 subjects with small and medium-sized cuff tears. Subjects were grouped according to anterior supraspinatus integrity (83 shoulders intact, group 1; and 29 shoulders with anterior supraspinatus tendon disruption, group 2). Functional assessments included visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and Constant score. Repair integrity was assessed by ultrasound examination.
Group 2 shoulders had greater mean tear width, length, and area (P < .0001) and greater supraspinatus muscle degenerative changes (P < .0001) compared with shoulders with an intact anterior supraspinatus tendon. There were no differences in demographics or baseline function (ASES score: 45 group 1 vs 46 group 2, P = .79; Constant score: 56 group 1 vs 52 group 2, P = .29) before surgery. There were no differences in any functional parameter (ASES score: 92 group 1 vs 93 group 2, P = .71; Constant score: 84 group 1 vs 85 group 2, P = .84) after surgery. There was no difference in tendon healing rates (93% group 1 vs 86% group 2; P = .26).
In the setting of painful small and medium-sized rotator cuff tears, disruption of the anterior supraspinatus tendon was associated with greater tear size and more advanced supraspinatus muscle degeneration. However, anterior supraspinatus tendon integrity had no influence on the clinical presentation or the functional and structural results of cuff repair surgery.
本研究的目的是比较中小型全层肩袖撕裂伴冈上肌完全断裂的肩关节与冈上肌前束完整的肩关节在关节镜下肩袖修复的基线功能和结果。
本研究评估了112例中小型肩袖撕裂患者。根据冈上肌前束的完整性将患者分组(83例冈上肌前束完整,为第1组;29例冈上肌前束断裂,为第2组)。功能评估包括疼痛视觉模拟量表、美国肩肘外科医师学会(ASES)评分、简易肩关节测试评分和康斯坦特评分。通过超声检查评估修复的完整性。
与冈上肌前束完整的肩关节相比,第2组肩关节的平均撕裂宽度、长度和面积更大(P <.0001),冈上肌肌肉退变更严重(P <.0001)。术前两组在人口统计学或基线功能方面无差异(ASES评分:第1组45分,第2组46分,P =.79;康斯坦特评分:第1组56分,第2组52分,P =.29)。术后两组在任何功能参数方面均无差异(ASES评分:第1组92分,第2组93分,P =.71;康斯坦特评分:第1组84分,第2组85分,P =.84)。肌腱愈合率无差异(第1组93%,第2组86%;P =.26)。
在疼痛性中小型肩袖撕裂的情况下,冈上肌前束断裂与更大的撕裂尺寸和更严重的冈上肌肌肉退变相关。然而,冈上肌前束的完整性对肩袖修复手术的临床表现或功能及结构结果没有影响。