Kim Sung-Jae, Jung Min, Lee Jae-Hoo, Kim Chul, Chun Yong-Min
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for Y.-M. Chun:
J Bone Joint Surg Am. 2014 Dec 17;96(24):2056-61. doi: 10.2106/JBJS.N.00293.
The purpose of this study was to compare the clinical outcomes and structural integrity after two techniques of arthroscopic anterosuperior rotator cuff repair: in continuity and disruption of the tear margin.
This study included fifty-nine patients who underwent arthroscopic repair of an anterosuperior rotator cuff tear that was done either by disrupting the margin between the subscapularis and supraspinatus tears (Group A) or by performing the repair in continuity without disrupting the margin (Group B). Clinical outcomes were assessed on the basis of a visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion of the shoulder. Subscapularis strength was assessed with use of the modified belly-press test. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed at six months after surgery to assess the structural integrity of the repair.
At the two-year follow-up evaluation, VAS pain scores, SSVs, ASES scores, UCLA shoulder scores, subscapularis strength, and active range of motion improved significantly in both groups compared with preoperatively (p < 0.001). There were no significant differences between groups for any of these follow-up measurements. On follow-up MRA or CTA, the overall retear rate did not differ significantly different between Group A (22%; five of twenty-three) and Group B (19%; six of thirty-two).
In conclusion, in patients treated with arthroscopic repair of anterosuperior full-thickness subscapularis and supraspinatus tears of the rotator cuff, the technique of in-continuity repair did not produce better clinical outcomes or structural integrity than the technique involving disruption of the tear margin. If the muscle in an anterosuperior rotator cuff tear is of good quality, it does not appear to matter whether the tear margin between the subscapularis and supraspinatus is preserved or disrupted.
本研究的目的是比较关节镜下肩袖前上部分修复的两种技术（即撕裂边缘连续修复和撕裂边缘不连续修复）后的临床疗效和结构完整性。
本研究纳入了59例接受关节镜下肩袖前上部分撕裂修复的患者，这些修复手术要么通过破坏肩胛下肌和冈上肌撕裂之间的边缘（A组），要么通过在不破坏边缘的情况下连续进行修复（B组）。根据视觉模拟量表（VAS）疼痛评分、主观肩关节评分（SSV）、美国肩肘外科医师学会（ASES）评分、加利福尼亚大学洛杉矶分校（UCLA）肩关节评分以及肩关节的主动活动范围来评估临床疗效。使用改良的腹部按压试验评估肩胛下肌力量。术后6个月进行磁共振关节造影（MRA）或计算机断层关节造影（CTA），以评估修复的结构完整性。
在两年的随访评估中，与术前相比，两组的VAS疼痛评分、SSV、ASES评分、UCLA肩关节评分、肩胛下肌力量和主动活动范围均有显著改善（p < 0.001）。在这些随访测量中，两组之间没有显著差异。在随访的MRA或CTA检查中，A组（22%；23例中的5例）和B组（19%；32例中的6例）的总体再撕裂率没有显著差异。
总之，在接受关节镜下肩袖前上部分全层肩胛下肌和冈上肌撕裂修复的患者中，连续修复技术在临床疗效或结构完整性方面并不比涉及破坏撕裂边缘的技术更好。如果肩袖前上部分撕裂的肌肉质量良好，肩胛下肌和冈上肌之间的撕裂边缘是否保留或破坏似乎并无影响。
