关节镜下肩峰下减压术对肩峰下撞击综合征真的有效吗：一项队列研究
Does arthroscopic sub-acromial decompression really work for sub-acromial impingement syndrome: a cohort study.
作者信息
Bhattacharyya Rahul, Edwards Kimberley, Wallace Angus W
机构信息
Trauma and Orthopaedics, West of Scotland deanery, UK.
出版信息
BMC Musculoskelet Disord. 2014 Sep 29;15:324. doi: 10.1186/1471-2474-15-324.
BACKGROUND
Health Economists in Denmark have reported poor outcomes and low and delayed return to work for patients treated for Sub-Acromial Impingement syndrome (SAIS) by Arthroscopic Sub-Acromial Decompression (ASAD). In this setting it is important to evaluate outcomes following this commonly performed operation to justify undertaking it on our patients. The purpose of the study was to evaluate the effectiveness of ASAD for patients with SAIS and correlate clinical outcome with rate of return to work.
METHODS
Prospective cohort study and retrospective review of data from the Nottingham Shoulder database. Inclusion criteria: Patients diagnosed clinically with SAIS by an experienced shoulder surgeon, who have failed conservative treatment (physiotherapy and sub-acromial injection), undergoing ASAD. Pre-operative and 6-month post-operative Oxford Shoulder Score (OSS) and Constant Score (CS) were compared. The rates of return to pre-operative work and hobbies were also analysed. Statistical analysis was carried out using the Wilcoxon signed rank test.
RESULTS
73 patients with OSS (51 also with CS documentation) were included. The improvement in median OSS between pre-operative (24) and 6-month follow-up (39) was +15 (Z = -6.726, p < 0.0001, T = 6, r = 0.55). The difference in median CS between pre-operative (39) and 6-month follow-up (67) was +28 (Z = -5.435, p < 0.0001,T = 6, r = 0.59). Improvement in median pain score was +5 (7,12, p < 0.0001) median ADL was +5.5 (10.5,16, p < 0.0001) median ROM was +13 (18,31, p < 0.0001) and median strength was +4 (3,7, p < 0.0001). 76% returned to their pre-operative level of work (mean time = 11.5 weeks post surgery). 79% returned to pre-operative hobbies at a mean of 11.8 weeks after surgery.
CONCLUSION
There is a significant improvement in both subjective and objective outcome 6 months after ASAD in patients with SAIS who have had previous failed conservative treatment. The rate of return to work was good for these patients in contrast to that reported for Danish patients. ASAD is a successful method of treatment for patients with SAIS who have had an initial trial of failed conservative treatment.
背景
丹麦的卫生经济学家报告称，接受关节镜下肩峰下减压术（ASAD）治疗的肩峰下撞击综合征（SAIS）患者预后较差，恢复工作的时间较晚且恢复率较低。在这种情况下，评估这种常见手术的预后对于证明对我们的患者进行该手术的合理性很重要。本研究的目的是评估ASAD对SAIS患者的有效性，并将临床结果与恢复工作的比率相关联。
方法
对诺丁汉肩部数据库的数据进行前瞻性队列研究和回顾性分析。纳入标准：由经验丰富的肩部外科医生临床诊断为SAIS且保守治疗（物理治疗和肩峰下注射）失败后接受ASAD的患者。比较术前和术后6个月的牛津肩部评分（OSS）和常数评分（CS）。还分析了恢复术前工作和爱好的比率。使用Wilcoxon符号秩检验进行统计分析。
结果
纳入了73例有OSS评分的患者（其中51例也有CS记录）。术前（24分）和6个月随访时（39分）的中位OSS改善为+15分（Z = -6.726，p < 0.0001，T = 6，r = 0.55）。术前（39分）和术后6个月（67分）的中位CS差异为+28分（Z = -5.435，p < 0.0001，T = 6，r = 0.59）。中位疼痛评分改善为+5分（7,12，p < 0.0001），中位日常生活活动（ADL）评分改善为+5.5分（10.5,16，p < 0.0001），中位关节活动度（ROM）改善为+13度（18,31，p < 0.0001），中位力量改善为+4分（3,7，p < 0.0001）。76%的患者恢复到术前的工作水平（平均时间为术后11.5周）。79%的患者在术后平均11.8周恢复到术前的爱好。
结论
对于先前保守治疗失败的SAIS患者，ASAD术后6个月主观和客观结果均有显著改善。与丹麦患者的报告情况相比，这些患者的恢复工作比率良好。ASAD是对最初保守治疗失败的SAIS患者的一种成功治疗方法。
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