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伴或不伴肩峰成形术的关节镜下全层肩袖撕裂修复术:一项为期2年随访的随机前瞻性试验

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.

作者信息

Abrams Geoffrey D, Gupta Anil K, Hussey Kristen E, Tetteh Elizabeth S, Karas Vasili, Bach Bernard R, Cole Brian J, Romeo Anthony A, Verma Nikhil N

机构信息

Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA Veterans Administration Palo Alto, Palo Alto, CA, USA

Florida Orthopedic Institute, Tampa, FL, USA.

出版信息

Am J Sports Med. 2014 Jun;42(6):1296-303. doi: 10.1177/0363546514529091. Epub 2014 Apr 14.

Abstract

BACKGROUND

Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated.

PURPOSE

To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 2.

METHODS

Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California-Los Angeles (UCLA) score, and Short Form-12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperative imaging was reviewed to classify the acromial morphologic type, acromial angle, and lateral acromial angulation.

RESULTS

A total of 114 patients were initially enrolled in the study, and 95 (83%; 43 nonacromioplasty, 52 acromioplasty) were available for a minimum 2-year follow-up. There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Within groups, there was a significant (P < .001) improvement in all functional outcome scores from preoperatively to all follow-up time points, including 2 years, for the nonacromioplasty and acromioplasty groups (ASES score: 55.1-91.5, 48.8-89.0; Constant score: 48.3-75.0, 51.9-78.7, respectively). There were no significant differences in functional outcomes between nonacromioplasty and acromioplasty groups or between subjects with different acromial features at any time point.

CONCLUSION

The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair with or without acromioplasty at 2 years postoperatively.

摘要

背景

肩峰成形术常在关节镜下修复肩袖撕裂时进行,但其对短期疗效的影响存在争议。

目的

报告行关节镜下全层肩袖撕裂修复术且伴或不伴肩峰成形术患者的短期临床疗效。

研究设计

随机对照试验;证据等级:2级。

方法

行关节镜下全层肩袖撕裂修复术的患者被随机分为肩峰成形术组或非肩峰成形术组。收集简单肩部试验(SST)、美国肩肘外科医师协会(ASES)评分、康斯坦特评分、加利福尼亚大学洛杉矶分校(UCLA)评分以及简明健康状况调查量表(SF - 12)健康评估结果,同时进行包括活动范围和握力计力量测试在内的体格检查。记录术中数据,包括撕裂大小、修复方式以及同期手术情况。定期进行随访检查,最长至2年。回顾术前影像学资料以对肩峰形态类型、肩峰角和肩峰外侧成角进行分类。

结果

共有114例患者最初纳入本研究,95例(83%;43例非肩峰成形术,52例肩峰成形术)进行了至少2年的随访。基线特征无显著差异,包括撕裂肌腱数量、修复方式、同期手术以及肩峰类型和角度。在组内,非肩峰成形术组和肩峰成形术组从术前到所有随访时间点(包括2年),所有功能结局评分均有显著改善(P <.001)(ASES评分:非肩峰成形术组从55.1提高到91.5,肩峰成形术组从48.8提高到89.0;康斯坦特评分:分别从48.3提高到75.0和从51.9提高到78.7)。在任何时间点,非肩峰成形术组和肩峰成形术组之间或具有不同肩峰特征的受试者之间,功能结局均无显著差异。

结论

本研究结果表明,术后2年,肩袖修复伴或不伴肩峰成形术的临床疗效无差异。

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