Buckley Taylor, Miller Richard, Nicandri Gregg, Lewis Richard, Voloshin Ilya
Department of Orthopaedics & Rehabilitation, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Department of Orthopaedics & Rehabilitation, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
J Shoulder Elbow Surg. 2014 Sep;23(9):1309-17. doi: 10.1016/j.jse.2013.12.009. Epub 2014 Mar 4.
The optimal method-subscapularis peel (SP) or lesser tuberosity osteotomy (LTO)-for takedown of the subscapularis during total shoulder arthroplasty (TSA) is controversial. This study compares the functional outcomes in a 2-surgeon cohort using the 2 techniques.
Patients who underwent TSA with a minimum 1 year of follow-up were evaluated. Physical and ultrasound examinations of the operative shoulder were performed. Radiographs were evaluated for osteotomy healing. Patients completed the Western Ontario Osteoarthritis of the Shoulder (WOOS) index, Disability of the Arm, Shoulder, and Hand (DASH), and Constant Scores.
Subscapularis tenotomy (n = 32) and LTO (n = 28) patients were similar in age, hand dominance, and sex. Follow-up duration for subscapularis tenotomy and LTO patients differed (31.7 vs 22.1 months, P = .003). SP patients demonstrated increased external rotation (69° ± 12° vs 60° ± 11°). Belly press and bear hug resistance were not significantly different. WOOS (P = .13), DASH (P = .71), and Constant Scores (P = .80) were not significantly different. After controlling for follow-up imbalance, the WOOS score difference was statistically significant (91.5 ± 10.2 for LTO vs 82.1 ± 18.9 for SP, P = .05) but not clinically significant. By ultrasonography assessment, 4 subscapularis tendons were abnormal in the SP group (3 attenuated, 1 ruptured), and all tendons were normal in the LTO group. Patients with an abnormal ultrasound result had significantly inferior WOOS (88 ± 15 vs 65 ± 18) and DASH (11.5 ± 11.4 vs 25.9 ± 11.2) scores. Belly press resistance was significantly decreased, bear hug resistance trended lower, and external rotation was increased in the abnormal ultrasound group.
Abnormal subscapularis tendons identified by ultrasonography only in the SP group correlate with clinically significant inferior functional outcome scores.
在全肩关节置换术（TSA）中，用于松解肩胛下肌的最佳方法——肩胛下肌剥离（SP）或小结节截骨术（LTO）——存在争议。本研究比较了两位外科医生使用这两种技术的功能结果。
对接受TSA且随访至少1年的患者进行评估。对手术肩部进行体格检查和超声检查。评估X线片以了解截骨愈合情况。患者完成了西安大略肩关节炎（WOOS）指数、手臂、肩部和手部功能障碍（DASH）以及Constant评分。
肩胛下肌切断术（n = 32）和LTO（n = 28）患者在年龄、利手和性别方面相似。肩胛下肌切断术和LTO患者的随访时间不同（31.7个月对22.1个月，P = 0.003）。SP患者的外旋增加（69°±12°对60°±11°）。腹部按压和抱熊试验阻力无显著差异。WOOS（P = 0.13）、DASH（P = 0.71）和Constant评分（P = 0.80）无显著差异。在控制随访不平衡后，WOOS评分差异具有统计学意义（LTO组为91.5±10.2，SP组为82.1±18.9，P = 0.05），但无临床意义。通过超声评估，SP组有4条肩胛下肌腱异常（3条变细，1条断裂），LTO组所有肌腱均正常。超声结果异常的患者WOOS（88±15对65±18）和DASH（11.5±11.4对25.9±11.2）评分显著更低。腹部按压阻力显著降低，抱熊试验阻力有降低趋势，异常超声组外旋增加。
仅在SP组中通过超声检查发现的肩胛下肌腱异常与临床上显著较差的功能结果评分相关。
