Pham T T, Bayle Iniguez X, Mansat P, Maubisson L, Bonnevialle N
Institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse, France.
Institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse, France.
Orthop Traumatol Surg Res. 2016 Feb;102(1):13-7. doi: 10.1016/j.otsr.2015.11.005. Epub 2016 Jan 18.
Although the arthroscopic technique is becoming the gold standard for rotator cuff tendon repair, there is no proof that this technique results in less postoperative pain compared to open repair. The aim of this study was to prospectively compare the postoperative pain level after arthroscopic or open rotator cuff repair and to define factors that could influence its course.
Between January 2012 and January 2013, 95 patients were operated for a rotator cuff tear: 45 using an arthroscopic technique and 50 an open technique. Daily analgesic use and self-evaluation of pain level using a visual analogic scale were recorded preoperatively and twice a day postoperatively during the first 6 weeks. These data were compared between the two groups and analyzed according to patients' demographic data and preoperative evaluation of the tear.
The preoperative pain level was equivalent in the two groups (P=0.22). Postoperatively, level-2 analgesic medication use was greater in the arthroscopic group after the 4th week (P=0.01). A pain-free shoulder was obtained before the 6th week in 75% and 66% of the patients after arthroscopic or open repair, respectively (P=0.34). There was a positive correlation between the preoperative and postoperative pain level (r=0.25; P=0.02). Work compensation patients experienced more pain postoperatively (P=0.08). Level-III analgesic medication use was greater for patients with massive rotator cuff tear (P=0.001).
No evidence was found on the superiority of arthroscopy versus open repair of rotator cuff tear concerning the postoperative pain level. The choice of the surgical technique should not be based on this argument.
II.
尽管关节镜技术正成为肩袖肌腱修复的金标准，但尚无证据表明与开放修复相比，该技术能减少术后疼痛。本研究的目的是前瞻性比较关节镜或开放肩袖修复术后的疼痛水平，并确定可能影响其进程的因素。
在2012年1月至2013年1月期间，95例患者接受了肩袖撕裂修复手术：45例采用关节镜技术，50例采用开放技术。术前以及术后前6周每天记录镇痛药的使用情况，并使用视觉模拟评分法让患者对疼痛水平进行自我评估。对两组数据进行比较，并根据患者的人口统计学数据和术前撕裂情况评估进行分析。
两组术前疼痛水平相当（P = 0.22）。术后，第4周后关节镜组2级镇痛药的使用量更多（P = 0.01）。关节镜或开放修复术后，分别有75%和66%的患者在第6周前获得无痛肩部（P = 0.34）。术前和术后疼痛水平呈正相关（r = 0.25；P = 0.02）。工伤赔偿患者术后疼痛更明显（P = 0.08）。巨大肩袖撕裂患者3级镇痛药的使用量更多（P = 0.001）。
在术后疼痛水平方面，未发现关节镜修复肩袖撕裂优于开放修复的证据。手术技术的选择不应基于这一因素。
II级。
