Geary Michael B, Elfar John C
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):220-4. doi: 10.1177/2151458515583895.
Rotator cuff tears (RCT) are a common clinical problem in the geriatric population, and debate exists over how to best provide pain relief and restore shoulder function. Treatment options can be broadly divided into nonsurgical and surgical, with the majority of patients initially placed on a trial of conservative therapy. For those with irreparable RCT, low functional demand, or interest in nonoperative management, there are a number of nonsurgical treatments to consider, including rehabilitation and injections of corticosteroids, hyaluronate, and platelet-rich plasma. Surgical treatment is increasingly common, as geriatric patients remain active with high functional demands. Studies in elderly populations have demonstrated satisfactory healing and clinical results following surgical repair. Predictors of poor outcome after repair are large tear size as well as higher stages of fatty infiltration. Decompression is a less invasive surgical option that has been shown to provide short-term pain relief, though the lasting effects may deteriorate over time. A number of factors must be weighed when considering which patients are likely to benefit from surgical intervention.
肩袖撕裂（RCT）是老年人群中常见的临床问题，关于如何最好地缓解疼痛和恢复肩部功能存在争议。治疗选择大致可分为非手术治疗和手术治疗，大多数患者最初会接受保守治疗试验。对于那些患有不可修复的RCT、功能需求较低或对非手术治疗感兴趣的患者，有多种非手术治疗方法可供考虑，包括康复治疗以及注射皮质类固醇、透明质酸盐和富血小板血浆。随着老年患者保持活跃且功能需求较高，手术治疗越来越普遍。对老年人群的研究表明，手术修复后愈合情况和临床效果令人满意。修复后预后不良的预测因素是撕裂口大以及脂肪浸润程度较高。减压是一种侵入性较小的手术选择，已被证明可提供短期疼痛缓解，不过其长期效果可能会随着时间推移而恶化。在考虑哪些患者可能从手术干预中获益时，必须权衡许多因素。
