Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, EC089, Hershey, PA 17033.
Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032. E-mail address for W.N. Levine:
J Bone Joint Surg Am. 2014 Jan 15;96(2):106-12. doi: 10.2106/JBJS.L.01649.
It is widely accepted that most patients treated with rotator cuff repair do well regardless of the integrity of the repair. The purpose of this cross-sectional study was to reexamine this concept and identify the factors affecting the outcomes of patients with a recurrent tear.
A cohort of patients who had been treated with rotator cuff repair completed a survey regarding satisfaction with the operatively treated shoulder, physical activity, and shoulder function. Ultrasonography was performed to determine rotator cuff integrity. Patients were divided into three age categories: younger than fifty-five years, fifty-five to sixty-five years, and sixty-six years or older. The relationships of the outcomes to patient age, repair integrity, and other demographic factors were analyzed.
Forty-seven (26%) of the 180 enrolled patients had a retear, defined as a full-thickness defect. In each age category, the satisfaction, ASES (American Shoulder and Elbow Surgeons), and SST (Simple Shoulder Test) scores in the retear group were significantly poorer than those in the no-retear group (p < 0.05). Within the retear group, all three scores were significantly better in the oldest age category (p < 0.05); there were no significant differences among the age categories within the no-retear group (p > 0.05). Simple regression analysis showed that younger age, a Workers' Compensation claim, and lower education level were significant predictors of poorer scores in patients with a retear (p < 0.05). Multiple regression analysis of the retear group showed that (1) lower education level and a Workers' Compensation claim were independent predictors of a poorer satisfaction score; (2) lower education level, younger age, and a Workers' Compensation claim were independent predictors of a poorer ASES score; and (3) lower education level was the only independent predictor of a poorer SST score (p < 0.01 for all).
The presence of a retear negatively affected the clinical outcomes following rotator cuff repair. This finding refutes the widely held concept that patients typically do well regardless of the repair integrity following rotator cuff repair. In patients with a retear, nonanatomic factors including younger age, lower education level, and a Workers' Compensation claim were associated with poorer outcomes.
人们普遍认为，大多数接受肩袖修复治疗的患者无论修复的完整性如何都能恢复良好。本横断面研究的目的是重新检验这一概念，并确定影响复发性撕裂患者治疗效果的因素。
一组接受肩袖修复治疗的患者完成了一项关于对手术治疗肩部满意度、身体活动和肩部功能的调查。进行超声检查以确定肩袖的完整性。患者被分为三个年龄组：小于 55 岁、55-65 岁和 66 岁及以上。分析了结果与患者年龄、修复完整性和其他人口统计学因素的关系。
在纳入的 180 名患者中，47 名（26%）有再撕裂，定义为全层缺陷。在每个年龄组中，再撕裂组的满意度、ASES（美国肩肘外科医师协会）和 SST（简单肩部测试）评分均明显低于无再撕裂组（p<0.05）。在再撕裂组中，最年长的年龄组的所有三个评分均显著更好（p<0.05）；而在无再撕裂组中，各年龄组之间无显著差异（p>0.05）。简单回归分析表明，年龄较小、工人赔偿索赔和较低的教育水平是再撕裂患者评分较差的显著预测因素（p<0.05）。再撕裂组的多元回归分析显示，（1）较低的教育水平和工人赔偿索赔是满意度评分较差的独立预测因素；（2）较低的教育水平、年龄较小和工人赔偿索赔是 ASES 评分较差的独立预测因素；（3）较低的教育水平是 SST 评分较差的唯一独立预测因素（所有 p<0.01）。
再撕裂的存在对肩袖修复后的临床结果产生负面影响。这一发现驳斥了肩袖修复后，无论修复完整性如何，患者通常都能恢复良好的普遍观点。在有再撕裂的患者中，非解剖因素，包括年龄较小、教育水平较低和工人赔偿索赔，与较差的结果相关。
