关节镜下修复肩袖撕裂术后的并发症。
Complications after arthroscopic revision rotator cuff repair.
机构信息
Harvard Shoulder Service, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
出版信息
Arthroscopy. 2013 Sep;29(9):1479-86. doi: 10.1016/j.arthro.2013.06.015.
PURPOSE
The purpose of this study was to determine the complication rate of arthroscopic revision rotator cuff repair (ARRCR).
METHODS
The retrospective review included 94 patients who underwent ARRCR performed by the 2 senior authors between January 2000 and June 2009 (mean age, 52 years; age range, 44 to 72 years). Sixty-four patients underwent 1 revision rotator cuff repair, 23 patients underwent 2 revisions, and 7 patients underwent 3 or more revisions. The rotator cuff tear at the time of the revision was characterized as massive (>5 cm) in 51 patients (54%), large (>3 to 5 cm) in 14 patients (15%), medium (1 to 3 cm) in 17 patients (18%), and small (<1 cm) in 12 patients (13%). There was a single-tendon tear in 12 patients (13%), 2 tears in 31 patients (33%), and 3 or 4 tears in 51 patients (54%). Additional procedures included revision acromioplasty (n = 66), distal clavicular excision (n = 19), biceps tenodesis (n = 52), suprascapular nerve release (n = 14), and loose anchor removal (n = 6).
RESULTS
Complications developed in 19 patients (20.2%) within 1 year of undergoing ARRCR. The complications included failure to heal (10.6%, n = 10), stiffness (7.4%, n = 7), infection (2.1%, n = 2), and nerve injury (1.1%, n = 1). A direct correlation was found between the complication rate and the number of revision surgeries: 14% after 1 revision, 17.4% after 2 revisions, 33% after 3 revisions, and 50% after 4 or more revisions. The minimum follow-up of all the patients in this study was 1 year. We continued to follow up every patient who was diagnosed with complications during this year until resolution of the complication, or we are still continuing to perform follow-up of these patients.
CONCLUSIONS
The complication rate after ARRCR is about twice the published rate for primary rotator cuff repair. There is a direct correlation between the complication rate and the number of revision surgeries. The most common complication recognized was failure to heal because of poor tissue quality.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
本研究旨在确定关节镜下修复肩袖撕裂（ARRCR）的并发症发生率。
方法
本回顾性研究纳入了 2000 年 1 月至 2009 年 6 月期间由 2 位资深作者实施的 94 例 ARRCR 患者（平均年龄 52 岁；年龄范围 44 岁至 72 岁）。64 例患者接受了 1 次修复，23 例患者接受了 2 次修复，7 例患者接受了 3 次或更多次修复。修复时肩袖撕裂的特征为巨大撕裂（>5cm）51 例（54%）、大撕裂（35cm）14 例（15%）、中撕裂（13cm）17 例（18%）和小撕裂（<1cm）12 例（13%）。12 例（13%）为单根肌腱撕裂，31 例（33%）为 2 根肌腱撕裂，51 例（54%）为 3 根或 4 根肌腱撕裂。其他手术包括翻修肩峰成形术（n=66）、锁骨远端切除术（n=19）、肱二头肌肌腱固定术（n=52）、肩胛上神经松解术（n=14）和松动锚钉取出术（n=6）。
结果
ARRCR 后 1 年内有 19 例（20.2%）患者出现并发症。并发症包括愈合失败（10.6%，n=10）、僵硬（7.4%，n=7）、感染（2.1%，n=2）和神经损伤（1.1%，n=1）。并发症发生率与翻修手术次数呈直接相关：1 次翻修后为 14%，2 次翻修后为 17.4%，3 次翻修后为 33%，4 次或更多次翻修后为 50%。本研究所有患者的最低随访时间为 1 年。我们继续对这一年内诊断为并发症的每位患者进行随访，直到并发症得到解决，或者我们仍在对这些患者进行随访。
结论
ARRCR 后的并发症发生率约为初次肩袖修复的两倍。并发症发生率与翻修手术次数呈直接相关。最常见的并发症是由于组织质量差导致愈合失败。
证据等级
IV 级，治疗性病例系列。
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